Provider Demographics
NPI:1134738800
Name:HULFACHOR, BENJAMIN SCOTT (APN)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:HULFACHOR
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 N CENTRAL PARK AVE APT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2062
Mailing Address - Country:US
Mailing Address - Phone:815-616-4559
Mailing Address - Fax:
Practice Address - Street 1:4143 N CENTRAL PARK AVE APT G
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2062
Practice Address - Country:US
Practice Address - Phone:815-616-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021004363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology