Provider Demographics
NPI:1417272212
Name:HURLEY, MARY A (APN/NNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:HURLEY
Suffix:
Gender:F
Credentials:APN/NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 S MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1425
Mailing Address - Country:US
Mailing Address - Phone:773-702-6185
Mailing Address - Fax:773-702-8720
Practice Address - Street 1:5721 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1425
Practice Address - Country:US
Practice Address - Phone:773-702-6185
Practice Address - Fax:773-702-8720
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008059363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal