MEDICARE: COLLEGE OF NURSING FACULTY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center		IL

General Provider Information

NPI Number	:	1720411135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEGE OF NURSING FACULTY PRACTICE

Provider Business Mailing Address
First Line	:	600 S PAULINA ST
Second Line	:	SUITE 1080
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-942-7117
Fax Number	:	312-942-3043

Provider Business Practice Location Address
First Line	:	1321 S PAULINA ST
Second Line	:	RM 109
City	:	CHICAGO
State	:	IL
Zip	:	60608-1221
Country	:	US
Telephone Number	:	773-534-7202
Fax Number	:	312-666-7371

Authorized Official
Title or Position	:	OFFICE DEAN/ AUTHORIZED OFFICIAL
Name	:	DEIDRE WESLEY
Credential	:
Telephone Number	:	312-942-0782

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	03/13/2026

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