Provider Demographics
NPI:1578752887
Name:NORTHERN ILLINOIS WOMEN'S CENTER
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS WOMEN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-963-4101
Mailing Address - Street 1:1400 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-1400
Mailing Address - Country:US
Mailing Address - Phone:815-963-4101
Mailing Address - Fax:815-963-6122
Practice Address - Street 1:1400 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1400
Practice Address - Country:US
Practice Address - Phone:815-963-4101
Practice Address - Fax:815-963-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002967261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility