Individual
BOSEUNG HALLIWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN-CNP
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 425-6400
(847) 425-6408
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 425-6400
(847) 425-6408
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209012602
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001783501
MEDICARE
—
05
—
1018026
—
VT
01
—
P00907931
MEDICARE RAILROAD CARRIER
—
Enumeration date
08/18/2010
Last updated
03/05/2021
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