Healthcare Provider Details

I. General information

NPI: 1154552198
Provider Name (Legal Business Name): HAYFAA I. ALDASOQI APN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1740 WEST TAYLOR STREET MEDICAL STAFF OFFICE
CHICAGO IL
60608
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7760
  • Fax:
Mailing address:
  • Phone: 312-355-2759
  • Fax: 312-413-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041286178
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209007611
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.007634
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: