Healthcare Provider Details

I. General information

NPI: 1962838862
Provider Name (Legal Business Name): CHRISTINE ELIE HERMOSILLO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 1ST ST
SPRING VALLEY IL
61362-1512
US

IV. Provider business mailing address

600 E 1ST ST
SPRING VALLEY IL
61362-1512
US

V. Phone/Fax

Practice location:
  • Phone: 815-664-4308
  • Fax: 815-663-1938
Mailing address:
  • Phone: 815-664-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.0019918
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: