Individual
IRYNA HORNBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
10140 191ST ST, MOKENA, IL 60448-9381
(708) 719-3527
(708) 719-3520
Mailing address
10140 191ST ST, MOKENA, IL 60448-9381
(708) 719-3527
(708) 719-3520
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.017053
IL
363LF0000X
Family Nurse Practitioner
28239908A
IN
363LF0000X
Family Nurse Practitioner
71007715A
IN
363LF0000X
Family Nurse Practitioner
COA.18108-NP
OH
363LF0000X
Family Nurse Practitioner
SP011970
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN2920087
MEDICARE PTAN
IN
Enumeration date
02/14/2012
Last updated
10/18/2024
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