Healthcare Provider Details

I. General information

NPI: 1699000315
Provider Name (Legal Business Name): CHERYL ANNE HAGER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 WEST 95TH STREET
OAK LAWN IL
60453
US

IV. Provider business mailing address

4440 WEST 95TH STREET
OAK LAWN IL
60453
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-3337
  • Fax: 708-684-4899
Mailing address:
  • Phone: 708-684-3337
  • Fax: 708-684-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-003026
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number209-001410
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: