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General NPI Number Information
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NPI Number | 1366949224
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Entity Type | Individual
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Provider Name | KAYLA MARIE HNILICKA MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 1701 E COLLEGE AVE
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City | BLOOMINGTON
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State | IL
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Zip | 61704-2101
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Country | US
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Telephone | 309-644-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 607 LIBERTY DR
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City | EAST PEORIA
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State | IL
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Zip | 61611-5567
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Country | US
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Telephone | 309-645-3010
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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 | 163WX0002X
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Taxonomy Name | High-Risk Obstetric Registered Nurse
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License Number | 041.390333
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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 | 209.017431
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License Number State | IL
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