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General NPI Number Information
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NPI Number | 1861218190
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Entity Type | Individual
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Provider Name | JULIA RUTH HALLACK APRN, CNP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 675 N SAINT CLAIR ST STE 19-100
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City | CHICAGO
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State | IL
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Zip | 60611-5969
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Country | US
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Telephone | 312-664-3278
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Fax | 312-695-5774
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Provider Business Mailing Address
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Address Line | 675 N SAINT CLAIR ST STE 19-100
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City | CHICAGO
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State | IL
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Zip | 60611-5969
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Country | US
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Telephone | 312-664-3278
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Fax | 312-695-5774
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 041.541613
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN.490237
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209.032172
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209032172
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License Number State | IL
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