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General NPI Number Information
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NPI Number | 1225218365
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS UNIVERSITY
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 21193 MALTA RD
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City | MALTA
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State | IL
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Zip | 60150-9600
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Country | US
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Telephone | 815-753-9010
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Fax | 815-753-9018
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Provider Business Mailing Address
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Address Line | 21193 MALTA RD
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City | MALTA
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State | IL
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Zip | 60150-9600
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Country | US
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Telephone | 815-753-9010
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Fax | 815-753-9018
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Authorized Official
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Title or Position | INTERIM DEAN
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Name | MRS. MARY PRITCHARD
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Credential | PH.D.
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Telephone | 815-753-6155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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