=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942750831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVOCATE GOOD SAMARITAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2016
-----------------------------------------------------
Last Update Date | 10/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4427 WOODWARD AVE
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-881-6437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4427 WOODWARD AVE
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-881-6437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CRITICAL CARE NURSE PRACTITIONER
-----------------------------------------------------
Name | HANNAH ABIGAIL KLOPPMANN
-----------------------------------------------------
Credential | AGACNP
-----------------------------------------------------
Telephone | 630-881-6437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 209014878
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------