Provider Demographics
NPI:1861609208
Name:NORTHWESTERN MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:NORTHWESTERN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER NEUROSURGERY
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:YONAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:312-926-5499
Mailing Address - Street 1:849 N FRANKLIN ST
Mailing Address - Street 2:UNIT # 610
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3113
Mailing Address - Country:US
Mailing Address - Phone:312-926-5499
Mailing Address - Fax:312-926-7464
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:FEINBERG 4-508
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-5499
Practice Address - Fax:312-926-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005996282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital