Provider Demographics
NPI:1184991465
Name:RUSH UNIVERSITY COLLEGE OF NURSING
Entity type:Organization
Organization Name:RUSH UNIVERSITY COLLEGE OF NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN, FACULTY PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN-BC
Authorized Official - Phone:312-942-7013
Mailing Address - Street 1:600 S PAULINA ST
Mailing Address - Street 2:ARMOUR ACADEMIC FACILITY SUITE 1080
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-3390
Mailing Address - Fax:312-942-2549
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-682-7400
Practice Address - Fax:630-221-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002261261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service