Provider Demographics
NPI:1679352660
Name:LEVINE, HAZEL LOUISE (FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:LOUISE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 N OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-9643
Mailing Address - Country:US
Mailing Address - Phone:502-819-4078
Mailing Address - Fax:
Practice Address - Street 1:1646 N OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-9643
Practice Address - Country:US
Practice Address - Phone:502-819-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.486644163W00000X
IL209.028223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse