Provider Demographics
NPI:1053822080
Name:NORTHESTERN ILLINOIS UNIVERSITY STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTHESTERN ILLINOIS UNIVERSITY STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT HEALTH SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HEIMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, APN, FNP
Authorized Official - Phone:773-442-5800
Mailing Address - Street 1:5500 N SAINT LOUIS AVE RM E-051
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4625
Mailing Address - Country:US
Mailing Address - Phone:773-442-5800
Mailing Address - Fax:773-442-5808
Practice Address - Street 1:5500 N SAINT LOUIS AVE RM E-051
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4625
Practice Address - Country:US
Practice Address - Phone:773-442-5800
Practice Address - Fax:773-442-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health