Organization
ICONIC NURSE NETWORK OUTREACH, INC
Active
Other names
Iconic Health Academy
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LAKHILA TELLIS RN, CHW (FOUNDER/PRESIDENT)
(312) 468-8604
Entity
Organization
Contact information
Practice address
730 N CHURCH ST # LL-3, ROCKFORD, IL 61103-6917
(312) 931-7376
Mailing address
730 N CHURCH ST # LL-3, ROCKFORD, IL 61103-6917
(312) 931-7376
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
163WW0000X
Wound Care Registered Nurse
—
—
172V00000X
Community Health Worker
Primary
—
—
251B00000X
Case Management Agency
—
—
364SC1501X
Community Health/Public Health Clinical Nurse Specialist
—
—
Other
Enumeration date
06/13/2024
Last updated
06/13/2024
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