Provider Demographics
NPI:1982669735
Name:DEPT OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:DEPT OF VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:312-469-3962
Mailing Address - Street 1:333 E HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E HURON ST
Practice Address - Street 2:ROOM 117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3004
Practice Address - Country:US
Practice Address - Phone:312-924-2513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002776261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service