Healthcare Provider Details

I. General information

NPI: 1306355151
Provider Name (Legal Business Name): LINDA MARIE HARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S DAMEN AVE STE 400
CHICAGO IL
60608-1169
US

IV. Provider business mailing address

7754 W HIGGINS RD
CHICAGO IL
60631-3350
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-4800
  • Fax: 312-564-4059
Mailing address:
  • Phone: 312-415-7952
  • Fax: 312-564-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN178573
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041134038
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: