Healthcare Provider Details

I. General information

NPI: 1609477744
Provider Name (Legal Business Name): NICOLE JEANINE STRODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/13/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

2650 RIDGE AVE. DEPT. OF ANESTHESIA
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2760
  • Fax:
Mailing address:
  • Phone: 847-570-2760
  • Fax: 847-570-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.022158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: