1801214143 NPI number — NORTHWEST SURGICAL HEALTHCARE LLC

Table of content: NICOLE VICTORIA LENNON PT, DPT (NPI 1881463818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801214143 NPI number — NORTHWEST SURGICAL HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST SURGICAL HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801214143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 W CENTRAL ROAD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60005-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-255-3338
Provider Business Mailing Address Fax Number:
847-255-3398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 W CENTRAL ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-255-3338
Provider Business Practice Location Address Fax Number:
847-255-3398
Provider Enumeration Date:
04/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
AKI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
847-255-3338

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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