Healthcare Provider Details

I. General information

NPI: 1518193994
Provider Name (Legal Business Name): CHARLES WAYNE NEHRING JR. CST/CFA/RSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2009
Last Update Date: 05/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

4919 W NEWPORT AVE
CHICAGO IL
60641-3559
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3200
  • Fax:
Mailing address:
  • Phone: 773-777-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number238.000023
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number238.000023
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: