Healthcare Provider Details

I. General information

NPI: 1558384933
Provider Name (Legal Business Name): MRS. PAMELA JOYCE HAERR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CREEK CT
PROSPECT HEIGHTS IL
60070-1305
US

IV. Provider business mailing address

2020 W HARRISON ST
CHICAGO IL
60612-3741
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-4690
  • Fax: 312-572-4659
Mailing address:
  • Phone: 312-572-4690
  • Fax: 312-572-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-000124
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: