Healthcare Provider Details

I. General information

NPI: 1932312089
Provider Name (Legal Business Name): JULIA BENNETT NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SALT CREEK LN SUITE # 111
HINSDALE IL
60521-2926
US

IV. Provider business mailing address

15 SALT CREEK LANE SUITE 111 IPC HOSPITALIST COMPANY
HINSDALE IL
60521
US

V. Phone/Fax

Practice location:
  • Phone: 630-371-0133
  • Fax: 630-371-0138
Mailing address:
  • Phone: 630-371-0133
  • Fax: 630-371-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041-332981
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-006621
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: