Basic Information
| Provider Information | |||||||||
| NPI: | 1003015595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCNICHOLAS | ||||||||
| FirstName: | FAITH | ||||||||
| MiddleName: | C. M. | ||||||||
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| Credential: | CPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 682 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600760682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479658552 | ||||||||
| FaxNumber: | 8479658552 | ||||||||
| Practice Location | |||||||||
| Address1: | 5244 W GREENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479658552 | ||||||||
| FaxNumber: | 8479658552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other |
No ID Information.