Healthcare Provider Details

I. General information

NPI: 1265126502
Provider Name (Legal Business Name): HINDRIK JAN PRENGER DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3154 N CLARK ST
CHICAGO IL
60657-4437
US

IV. Provider business mailing address

3154 N CLARK ST
CHICAGO IL
60657-4437
US

V. Phone/Fax

Practice location:
  • Phone: 773-751-7800
  • Fax:
Mailing address:
  • Phone: 773-751-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF352085-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: