Healthcare Provider Details

I. General information

NPI: 1770957318
Provider Name (Legal Business Name): KIMBERLY ANN HURLEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN BUDIL APN

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

16137 LOCKWOOD AVE
OAK FOREST IL
60452-3820
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-3844
  • Fax:
Mailing address:
  • Phone: 708-557-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209013599
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: