MEDICARE: MRS. PAMELA JOYCE HAERR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	209-000124	IL

General Provider Information

NPI Number	:	1558384933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA JOYCE HAERR

Provider Business Mailing Address
First Line	:	2020 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3741
Country	:	US
Telephone Number	:	312-572-4690
Fax Number	:	312-572-4602

Provider Business Practice Location Address
First Line	:	102 CREEK CT
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1305
Country	:	US
Telephone Number	:	312-572-4690
Fax Number	:	312-572-4659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/29/2015

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