1104515972 NPI number — DR. GENEVIEVE MARIE SPITTLER DNP APRN AGACNP-BC

Table of content: DR. GENEVIEVE MARIE SPITTLER DNP APRN AGACNP-BC (NPI 1104515972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104515972 NPI number — DR. GENEVIEVE MARIE SPITTLER DNP APRN AGACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPITTLER
Provider First Name:
GENEVIEVE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP APRN AGACNP-BC
Provider Gender Code:
F

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:
1104515972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
261 BUTTE VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60490-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-267-4137
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RUSH UNIVERSITY MEDICAL GROUP
Provider Second Line Business Practice Location Address:
2040 OGDEN AVENUE, SUITE 304
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-898-3727
Provider Business Practice Location Address Fax Number:
630-499-2430
Provider Enumeration Date:
05/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  209.027318 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com