Organization Name: | NORTHERN ILLINOIS UNIVERSITY |
NPI Number: | 1225218365 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY PRITCHARD (INTERIM DEAN) |
Mailing Address: | 21193 Malta Rd Malta |
State: | IL US |
Postal Code: | 601509600 |
Phone Number: | 8157539010 |
Fax Number: | 8157539018 |
NPI Enumeration Date: | 11/06/2007 |
NPI Last Update Date: | 04/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |