Provider Demographics
NPI:1326096702
Name:LOEK, WAYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:LOEK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 RICHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7708
Mailing Address - Country:US
Mailing Address - Phone:630-910-0753
Mailing Address - Fax:630-985-9048
Practice Address - Street 1:1228 RICHFIELD CT
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-7708
Practice Address - Country:US
Practice Address - Phone:630-910-0753
Practice Address - Fax:630-985-9048
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003966174400000X
IN28094020A174400000X
WI193568367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist