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General NPI Number Information
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NPI Number | 1942690672
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MEMORIAL HEALTHCARE
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 1030 N WOLCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60622-5986
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Country | US
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Telephone | 847-471-3513
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 N WOLCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60622-5986
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Country | US
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Telephone | 847-471-3513
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITONER
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Name | MS. KELLY JO NELSON
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Credential | BSN, MSN, FNP
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Telephone | 847-471-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 209012197
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License Number State | IL
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