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General NPI Number Information
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NPI Number | 1861102998
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Entity Type | Organization
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Legal Business Name | HIDDEN PINE FAMILY PRACTICE INC
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 3540 SEVEN BRIDGES DR STE 100
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City | WOODRIDGE
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State | IL
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Zip | 60517-1254
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Country | US
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Telephone | 331-269-9896
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Fax | 888-388-0996
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Provider Business Mailing Address
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Address Line | 3540 SEVEN BRIDGES DR STE 100
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City | WOODRIDGE
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State | IL
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Zip | 60517-1254
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Country | US
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Telephone | 847-420-9664
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Fax | 888-388-0996
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARTHUR OLIVEROS
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Credential |
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Telephone | 331-269-9896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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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 |
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License Number State |
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