Provider Demographics
NPI:1699855031
Name:HULFORD, DEBRA JEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:HULFORD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17910 HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1911
Mailing Address - Country:US
Mailing Address - Phone:708-224-9479
Mailing Address - Fax:
Practice Address - Street 1:16450 104TH AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5441
Practice Address - Country:US
Practice Address - Phone:708-349-0070
Practice Address - Fax:708-349-0077
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005607363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner