Organization
GLOW HEALTH AND WELLNESS MEDICAL SPA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAJUANA D. JOHNSON FNP (OWNER, MANAGER)
(630) 901-2879
Entity
Organization
Contact information
Practice address
1528 W MONROE ST STE 100, CHICAGO, IL 60607-2460
(630) 901-2879
Mailing address
1001 W 15TH ST UNIT 320, CHICAGO, IL 60608-2778
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
209008594
IL
261QI0500X
Infusion Therapy Clinic/Center
209008594
IL
Other
Enumeration date
09/20/2017
Last updated
09/20/2017
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