Provider Demographics
NPI:1023032885
Name:WANSTREET, LANA ELAINE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:ELAINE
Last Name:WANSTREET
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:LANA
Other - Middle Name:ELAINE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:11495 SOUTHPOINT LN
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-4976
Mailing Address - Country:US
Mailing Address - Phone:618-713-6441
Mailing Address - Fax:
Practice Address - Street 1:11495 SOUTHPOINT LN
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-4976
Practice Address - Country:US
Practice Address - Phone:618-713-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000788367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL577300Medicare ID - Type Unspecified