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General NPI Number Information
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NPI Number | 1255715488
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 710 N FAIRBANKS CT # 7121
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City | CHICAGO
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State | IL
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Zip | 60611-3013
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Country | US
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Telephone | 312-926-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 710 N FAIRBANKS CT # 7121
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City | CHICAGO
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State | IL
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Zip | 60611-3013
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Country | US
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Telephone | 312-926-2000
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIETITIAN
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Name | CAITLIN ELYSE BERANEK
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Credential | RD, LDN, CNSC
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Telephone | 312-926-7437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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