Healthcare Provider Details

I. General information

NPI: 1669051272
Provider Name (Legal Business Name): HEIDY HWANG EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 PICARDY CT
LONG GROVE IL
60047-5143
US

IV. Provider business mailing address

1612 PICARDY CT
LONG GROVE IL
60047-5143
US

V. Phone/Fax

Practice location:
  • Phone: 847-309-2610
  • Fax:
Mailing address:
  • Phone: 847-309-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number051290650
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: