Provider Demographics
NPI:1275688160
Name:NORTHERN ILLINOIS UNIVERSITY HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS UNIVERSITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, HEALTH SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:815-753-1311
Mailing Address - Street 1:518 LUCINDA AVE.
Mailing Address - Street 2:HEALTH SERVICES BUILDING
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2854
Mailing Address - Country:US
Mailing Address - Phone:815-753-1311
Mailing Address - Fax:815-753-9570
Practice Address - Street 1:518 LUCINDA AVE
Practice Address - Street 2:HEALTH SERVICES BUILDING
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115
Practice Address - Country:US
Practice Address - Phone:815-753-1311
Practice Address - Fax:815-753-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health