Healthcare Provider Details

I. General information

NPI: 1023446754
Provider Name (Legal Business Name): HILLARI HANLEY APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 WILLOW SPRINGS RD
LA GRANGE HIGHLANDS IL
60525-4591
US

IV. Provider business mailing address

13723 W 89TH PL.
WHEATON IN
60187-5423
US

V. Phone/Fax

Practice location:
  • Phone: 708-482-9700
  • Fax: 708-482-0217
Mailing address:
  • Phone: 630-384-2699
  • Fax: 708-491-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.010541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: