Provider Demographics
NPI:1568190114
Name:HUTCHERSON, HALEY MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:HUTCHERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E WATERSIDE DR UNIT 3014
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-0020
Mailing Address - Country:US
Mailing Address - Phone:817-586-8003
Mailing Address - Fax:
Practice Address - Street 1:9718 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1007
Practice Address - Country:US
Practice Address - Phone:773-233-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025711363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty