Healthcare Provider Details

I. General information

NPI: 1659845998
Provider Name (Legal Business Name): HIRA OAD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 CLAIRE CT
GLENVIEW IL
60025-7635
US

IV. Provider business mailing address

2050 CLAIRE CT
GLENVIEW IL
60025-7635
US

V. Phone/Fax

Practice location:
  • Phone: 847-467-7423
  • Fax: 847-556-1715
Mailing address:
  • Phone: 847-467-7423
  • Fax: 847-556-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: