Provider Demographics
NPI:1215162409
Name:NORTHWESTERN MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:NORTHWESTERN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UEBELHOR
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:207-232-9807
Mailing Address - Street 1:3237 N RACINE AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9303
Mailing Address - Country:US
Mailing Address - Phone:207-232-9708
Mailing Address - Fax:
Practice Address - Street 1:251 E. HURON ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-472-4218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007567282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital