Healthcare Provider Details

I. General information

NPI: 1679239230
Provider Name (Legal Business Name): COLLEGE OF NURSING FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S KING DR
CHICAGO IL
60616-3452
US

IV. Provider business mailing address

300 S ASHLAND AVE STE 101E
CHICAGO IL
60607-3856
US

V. Phone/Fax

Practice location:
  • Phone: 773-534-7202
  • Fax: 312-666-7371
Mailing address:
  • Phone: 312-942-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SALLY LEMKE
Title or Position: DIRECTOR
Credential:
Phone: 312-563-6830