Provider Demographics
NPI:1083656227
Name:FEDER, ESTHER R (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:R
Last Name:FEDER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ESTHER
Other - Middle Name:R
Other - Last Name:SJOQUIST AND CHATTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2202 HARLEM ROAD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-654-5342
Practice Address - Street 1:2202 HARLEM ROAD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2754
Practice Address - Country:US
Practice Address - Phone:815-877-4848
Practice Address - Fax:815-654-5342
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041222417163W00000X
IL209-001963367500000X
IL209001963367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01455260OtherRAILROAD MEDICARE
IL969131Medicare ID - Type Unspecified
593490011Medicare PIN