Provider Demographics
NPI:1093148496
Name:COLLEGE OF NURSING FACULTY PRACTICE
Entity Type:Organization
Organization Name:COLLEGE OF NURSING FACULTY PRACTICE
Other - Org Name:HUGINNIE CRANE ADOLESCENT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE DEAN/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-0782
Mailing Address - Street 1:600 S PAULINA ST
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-7117
Mailing Address - Fax:312-942-3043
Practice Address - Street 1:2245 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2910
Practice Address - Country:US
Practice Address - Phone:773-534-7582
Practice Address - Fax:773-534-7194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH UNIVERSITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center