Individual
LAURA LORRAINE HACKWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,CNP
Contact information
Practice address
510 FULLERTON RD, SWANSEA, IL 62226-2970
(618) 233-7666
(618) 233-7461
Mailing address
510 FULLERTON RD, SWANSEA, IL 62226-2970
(618) 233-7666
(618) 233-7461
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209006150
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209006150
—
IL
01
—
P00372772
MEDICARE RR PTAN
IL
Enumeration date
08/18/2006
Last updated
10/13/2010
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