Healthcare Provider Details

I. General information

NPI: 1093148496
Provider Name (Legal Business Name): COLLEGE OF NURSING FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 W JACKSON BLVD
CHICAGO IL
60612-2910
US

IV. Provider business mailing address

600 S PAULINA ST SUITE 1080
CHICAGO IL
60612-3806
US

V. Phone/Fax

Practice location:
  • Phone: 773-534-7582
  • Fax: 773-534-7194
Mailing address:
  • Phone: 312-942-7117
  • Fax: 312-942-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DEIDRE WESLEY
Title or Position: OFFICE DEAN/AUTHORIZED OFFICIAL
Credential:
Phone: 312-942-0782