Provider Demographics
NPI:1801780838
Name:KWAK, HAILEY M (APRN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HAILEY
Middle Name:M
Last Name:KWAK
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 ADDERLY LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4755
Mailing Address - Country:US
Mailing Address - Phone:847-363-0390
Mailing Address - Fax:
Practice Address - Street 1:1015 N CORPORATE CIR STE D
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7813
Practice Address - Country:US
Practice Address - Phone:847-599-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032204363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty