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General NPI Number Information
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NPI Number | 1205154440
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Entity Type | Organization
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Legal Business Name | SWEDISHAMERICAN HOSPITAL
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 204 E PRAIRIE ST
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City | MARENGO
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State | IL
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Zip | 60152-3107
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Country | US
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Telephone | 779-696-9553
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1567
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City | ROCKFORD
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State | IL
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Zip | 61110-0067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | DON DANIELS
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Credential |
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Telephone | 815-966-2084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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