Provider Demographics
NPI:1497789606
Name:NORTHSHORE WOMEN'S HEALTH ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:NORTHSHORE WOMEN'S HEALTH ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCENTEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-432-1558
Mailing Address - Street 1:767 PARK AVE W
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2400
Mailing Address - Country:US
Mailing Address - Phone:847-432-1558
Mailing Address - Fax:847-432-6981
Practice Address - Street 1:767 PARK AVE W
Practice Address - Street 2:SUITE 240
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2400
Practice Address - Country:US
Practice Address - Phone:847-432-1558
Practice Address - Fax:847-432-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04915056OtherBLUE CROSS BLUE SHIELD
IL461360Medicare ID - Type Unspecified