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General NPI Number Information
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NPI Number | 1114763281
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Entity Type | Individual
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Provider Name | TELLY HUNTER
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Gender | Female
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 725 AMERICAN AVE
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City | WAUKESHA
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State | WI
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Zip | 53188-5031
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Country | US
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Telephone | 262-928-7087
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Fax |
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Provider Business Mailing Address
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Address Line | 1786 KELBERG AVE
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-4808
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Country | US
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Telephone | 847-660-8754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15626
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 15626-33
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License Number State | WI
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