Healthcare Provider Details

I. General information

NPI: 1649272154
Provider Name (Legal Business Name): BETH NACHTSHEIM BOLICK RN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

722 SEWARD ST
EVANSTON IL
60202-2913
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3646
  • Fax:
Mailing address:
  • Phone: 847-475-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: