Healthcare Provider Details

I. General information

NPI: 1700408366
Provider Name (Legal Business Name): HAILIE SHEA DOYLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE B305
MCHENRY IL
60050-8418
US

IV. Provider business mailing address

4309 W MEDICAL CENTER DR STE B305
MCHENRY IL
60050-8418
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7400
  • Fax: 312-695-3644
Mailing address:
  • Phone: 847-802-7400
  • Fax: 312-695-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021011
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021011
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: