Healthcare Provider Details

I. General information

NPI: 1447304431
Provider Name (Legal Business Name): DORIS SHUWEN HUANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHUWEN HUANG FNP

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 W JACKSON BLVD
CHICAGO IL
60644-4332
US

IV. Provider business mailing address

PO BOX 7513
CHICAGO IL
60680-7513
US

V. Phone/Fax

Practice location:
  • Phone: 773-921-8000
  • Fax:
Mailing address:
  • Phone: 312-925-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-003913
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209003913
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: