Healthcare Provider Details

I. General information

NPI: 1225543937
Provider Name (Legal Business Name): NICOLE HARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S RIVER RD
DES PLAINES IL
60018-6001
US

IV. Provider business mailing address

23708 W COTSWALD DR
PLAINFIELD IL
60585-8590
US

V. Phone/Fax

Practice location:
  • Phone: 872-777-1750
  • Fax:
Mailing address:
  • Phone: 815-474-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.016417
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: