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NPI Code Detail

MEDICARE: DR. NICHOLAS IDEN DNP

MEDICARE: DR. NICHOLAS IDEN DNP
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
1367500000XCertified Registered Nurse Anesthetist041409236IL
2367500000XCertified Registered Nurse Anesthetist209026518IL

General Provider Information

NPI Number : 1780301028
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS IDEN DNP
Provider Business Mailing Address
First Line : 2615 N FORREST LN
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-2241
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 888-584-7888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2022
Last Update Date : 12/16/2025

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