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General NPI Number Information
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NPI Number | 1578752887
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS WOMEN'S CENTER
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1400 BROADWAY SUITE 201
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City | ROCKFORD
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State | IL
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Zip | 61104-1400
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Country | US
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Telephone | 815-963-4101
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Fax | 815-963-6122
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Provider Business Mailing Address
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Address Line | 1400 BROADWAY SUITE 201
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City | ROCKFORD
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State | IL
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Zip | 61104-1400
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Country | US
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Telephone | 815-963-4101
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Fax | 815-963-6122
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DENNIS D CHRISTENSEN
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Credential | M.D.
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Telephone | 815-963-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | 7002967
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License Number State | IL
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