Healthcare Provider Details

I. General information

NPI: 1902742844
Provider Name (Legal Business Name): ALICIA HARGRETT RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 CICERO AVE STE 12
OAK FOREST IL
60452-4136
US

IV. Provider business mailing address

25337 FEDERAL CIR
PLAINFIELD IL
60544-2487
US

V. Phone/Fax

Practice location:
  • Phone: 773-619-5464
  • Fax:
Mailing address:
  • Phone: 773-619-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041493107
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number041493107
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041493107
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: