Healthcare Provider Details

I. General information

NPI: 1245852730
Provider Name (Legal Business Name): STEFANIE HAYES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 S MARYLAND AVE
CHICAGO IL
60637-1425
US

IV. Provider business mailing address

1305 S MICHIGAN AVE APT 1207
CHICAGO IL
60605-3400
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 815-274-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041421637
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: