Individual
HIRA OAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2050 CLAIRE CT, GLENVIEW, IL 60025-7635
(847) 467-7423
(847) 556-1715
Mailing address
2050 CLAIRE CT, GLENVIEW, IL 60025-7635
(847) 467-7423
(847) 556-1715
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209018612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041430469
RN STATE LICENSE
IL
Enumeration date
01/21/2019
Last updated
01/21/2019
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