Provider Demographics
NPI:1336354166
Name:NORTHWESTERN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:NORTHWESTERN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPLANT NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:GERETTE
Authorized Official - Last Name:KAMUDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, APN
Authorized Official - Phone:312-243-1362
Mailing Address - Street 1:1141 W WASHINGTON BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2026
Mailing Address - Country:US
Mailing Address - Phone:312-243-1362
Mailing Address - Fax:
Practice Address - Street 1:675 NORTH SAINT ST. CLAIR, SUITE 17-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-1728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital