MEDICARE: MRS. BETH NACHTSHEIM BOLICK RN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0222X	Critical Care Pediatric Nurse Practitioner		IL

General Provider Information

NPI Number	:	1649272154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH NACHTSHEIM BOLICK RN CNP

Provider Business Mailing Address
First Line	:	722 SEWARD ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-2913
Country	:	US
Telephone Number	:	847-475-0977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1653 W CONGRESS PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3833
Country	:	US
Telephone Number	:	312-942-3646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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