Healthcare Provider Details

I. General information

NPI: 1689578403
Provider Name (Legal Business Name): KASHMIR HOLLISTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 S MARYLAND AVE
CHICAGO IL
60637-1425
US

IV. Provider business mailing address

1488 CORAL CV
HOBART IN
46342-6226
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone: 219-771-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209.036713
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: