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NPI Code Detail

MEDICARE: MRS. CRISCIEL P. HIDALGO APN-CNP

MEDICARE: MRS. CRISCIEL P. HIDALGO APN-CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner209012282IL
2363LF0000XFamily Nurse Practitioner209012282IL

General Provider Information

NPI Number : 1104214287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRISCIEL P. HIDALGO APN-CNP
Provider Business Mailing Address
First Line : 1216 BEVERLY DR
Second Line :
City : LAKE VILLA
State : IL
Zip : 60046-6408
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2520 ELISHA AVE
Second Line :
City : ZION
State : IL
Zip : 60099-2676
Country : US
Telephone Number : 800-322-9183
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/25/2014
Last Update Date : 05/20/2026

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