Basic Information
| Provider Information | |||||||||
| NPI: | 1184991465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUSH UNIVERSITY COLLEGE OF NURSING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S PAULINA ST | ||||||||
| Address2: | ARMOUR ACADEMIC FACILITY SUITE 1080 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129423390 | ||||||||
| FaxNumber: | 3129422549 | ||||||||
| Practice Location | |||||||||
| Address1: | 7530 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605173100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306827400 | ||||||||
| FaxNumber: | 6302217640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2011 | ||||||||
| LastUpdateDate: | 11/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | WIDEMAN | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE DEAN, FACULTY PRACTICE | ||||||||
| AuthorizedOfficialTelephone: | 3129427013 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DNP, RN-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 209002261 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.