Basic Information
| Provider Information | |||||||||
| NPI: | 1619553641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEDGES | ||||||||
| FirstName: | CRINDY | ||||||||
| MiddleName: | NOLEE | ||||||||
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| Credential: | RN, IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 W WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615202497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096475240 | ||||||||
| FaxNumber: | 3096495108 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615202608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096496899 | ||||||||
| FaxNumber: | 3096495108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2021 | ||||||||
| LastUpdateDate: | 03/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | L-162934 | IL | N | Nursing Service Providers | Registered Nurse | Lactation Consultant | 163WL0100X | 041455600 | IL | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.