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General NPI Number Information
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NPI Number | 1508139023
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Entity Type | Individual
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Provider Name | IRYNA HORNBACK FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 10140 191ST ST
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City | MOKENA
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State | IL
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Zip | 60448-9381
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Country | US
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Telephone | 708-719-3527
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Fax | 708-719-3520
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Provider Business Mailing Address
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Address Line | 10140 191ST ST
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City | MOKENA
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State | IL
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Zip | 60448-9381
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Country | US
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Telephone | 708-719-3527
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Fax | 708-719-3520
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA.18108-NP
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License Number State | OH
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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 | 28239908A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.017053
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP011970
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71007715A
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License Number State | IN
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