Healthcare Provider Details

I. General information

NPI: 1568190114
Provider Name (Legal Business Name): HALEY MARIE HUTCHERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9718 S HALSTED ST
CHICAGO IL
60628-1007
US

IV. Provider business mailing address

455 E WATERSIDE DR UNIT 3014
CHICAGO IL
60601-0020
US

V. Phone/Fax

Practice location:
  • Phone: 773-233-4100
  • Fax:
Mailing address:
  • Phone: 817-586-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.025711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: