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General NPI Number Information
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NPI Number | 1275075665
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CHICAGO MEDICAL CENTER
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 S STATE ST APT. 4L
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City | CHICAGO
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State | IL
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Zip | 60605-3011
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Country | US
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Telephone | 505-450-9185
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Fax |
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Authorized Official
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Title or Position | ACUTE CARE NURSE PRACTITIONER
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Name | ANNA C FULLER
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Credential | APN
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Telephone | 505-450-9185
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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 | 209014987
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License Number State | IL
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