Provider Demographics
NPI:1841638079
Name:HARDISON, XIOMARA ESTHER (APN, NP-C)
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:ESTHER
Last Name:HARDISON
Suffix:
Gender:F
Credentials:APN, NP-C
Other - Prefix:
Other - First Name:XIOMARA
Other - Middle Name:ESTHER
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 S CHICAGO BEACH DR
Mailing Address - Street 2:APT 1316N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2148
Mailing Address - Country:US
Mailing Address - Phone:773-576-2420
Mailing Address - Fax:
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:JESSE BROWN VA MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-6368
Practice Address - Fax:312-569-8986
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041274161163WA2000X, 163WC0400X, 163WC1500X
IL209010089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health