Basic Information
| Provider Information | |||||||||
| NPI: | 1861837718 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANN AND ROBERT H. LURIE CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9849 S. CLIFTON PARK AVE | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733171839 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 EAST CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122274000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2013 | ||||||||
| LastUpdateDate: | 05/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | SYLVIA | ||||||||
| AuthorizedOfficialMiddleName: | PEREZ | ||||||||
| AuthorizedOfficialTitleorPosition: | APN, MSN, CPNP | ||||||||
| AuthorizedOfficialTelephone: | 7733171839 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | APN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 209.009698041.348598 | IL | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.