=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336354166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWESTERN MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 NORTH SAINT ST. CLAIR, SUITE 17-200
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-926-1728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1141 W WASHINGTON BLVD APT 202
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-243-1362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TRANSPLANT NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. DONNA GERETTE KAMUDA
-----------------------------------------------------
Credential | RN, MS, APN
-----------------------------------------------------
Telephone | 312-243-1362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------