Provider Demographics
NPI:1417619172
Name:ROONEY, TRACEY (APRN-CRNA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:ROONEY
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:KONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:616 W FULTON ST APT 211
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1264
Mailing Address - Country:US
Mailing Address - Phone:608-669-0022
Mailing Address - Fax:
Practice Address - Street 1:225 EAST CHICAGO AVENUE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024159367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered