Healthcare Provider Details

I. General information

NPI: 1104214287
Provider Name (Legal Business Name): CRISCIEL P. HIDALGO APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2014
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ELISHA AVE
ZION IL
60099-2676
US

IV. Provider business mailing address

1216 BEVERLY DR
LAKE VILLA IL
60046-6408
US

V. Phone/Fax

Practice location:
  • Phone: 800-322-9183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012282
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012282
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: