Healthcare Provider Details

I. General information

NPI: 1053896654
Provider Name (Legal Business Name): HERMANCE FORTUNE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINCOLN CTR STE 1030
OAKBROOK TERRACE IL
60181-4258
US

IV. Provider business mailing address

1027 PARK RUN DR
FRANKLIN TN
37067-8673
US

V. Phone/Fax

Practice location:
  • Phone: 314-540-8814
  • Fax:
Mailing address:
  • Phone: 314-540-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31597
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018015056
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017891
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018015056
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: