Individual
STEPHANIE MORA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
Mailing address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
209.
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209023388
IL
Other
Enumeration date
06/11/2021
Last updated
08/10/2021
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