Healthcare Provider Details

I. General information

NPI: 1366949224
Provider Name (Legal Business Name): KAYLA MARIE HNILICKA MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2101
US

IV. Provider business mailing address

607 LIBERTY DR
EAST PEORIA IL
61611-5567
US

V. Phone/Fax

Practice location:
  • Phone: 309-644-3440
  • Fax:
Mailing address:
  • Phone: 309-645-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number041.390333
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017431
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: