Healthcare Provider Details

I. General information

NPI: 1285521740
Provider Name (Legal Business Name): SHAKITA HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 W WASHINGTON BLVD APT 2
CHICAGO IL
60644-6401
US

IV. Provider business mailing address

5303 W WASHINGTON BLVD APT 2
CHICAGO IL
60644-6401
US

V. Phone/Fax

Practice location:
  • Phone: 312-409-0159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.032514
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: