Healthcare Provider Details

I. General information

NPI: 1720806334
Provider Name (Legal Business Name): JORDAN HULSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SUPERIOR ST
CHICAGO IL
60611-2914
US

IV. Provider business mailing address

1130 N DEARBORN ST APT 203
CHICAGO IL
60610-7105
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 913-433-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number041523016
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: