Healthcare Provider Details

I. General information

NPI: 1104537471
Provider Name (Legal Business Name): ERIN RENEE HURLEY APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10209 W LINCOLN HWY
FRANKFORT IL
60423-1279
US

IV. Provider business mailing address

10209 W LINCOLN HWY
FRANKFORT IL
60423-1279
US

V. Phone/Fax

Practice location:
  • Phone: 708-998-2979
  • Fax:
Mailing address:
  • Phone: 708-998-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209026517
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: