Provider Demographics
NPI:1255759668
Name:NWL ACQUISITION S.C.
Entity type:Organization
Organization Name:NWL ACQUISITION S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-416-8289
Mailing Address - Street 1:1560 WALL ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1123
Mailing Address - Country:US
Mailing Address - Phone:630-355-1533
Mailing Address - Fax:630-416-8306
Practice Address - Street 1:1560 WALL ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1123
Practice Address - Country:US
Practice Address - Phone:630-355-1533
Practice Address - Fax:630-416-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service