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General NPI Number Information
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NPI Number | 1790095065
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Entity Type | Organization
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Legal Business Name | CITY OF EVANSTON HEALTH DEPARTMENT
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 2100 RIDGE AVE
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City | EVANSTON
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State | IL
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Zip | 60201-2716
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Country | US
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Telephone | 847-866-2057
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Fax | 847-448-8125
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Provider Business Mailing Address
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Address Line | 2100 RIDGE AVE ROOM G-500
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City | EVANSTON
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State | IL
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Zip | 60201-2716
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Country | US
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Telephone | 847-866-2957
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Fax | 847-448-8125
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. EVONDA THOMAS
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Credential | RN MSN DHA(C)
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Telephone | 847-844-2957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 074390907
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License Number State | IL
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