Provider Demographics
NPI:1528207081
Name:STEWART, ELIZABETH ANDERSON (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANDERSON
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 KISH HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9602
Mailing Address - Country:US
Mailing Address - Phone:630-936-4029
Mailing Address - Fax:630-936-4032
Practice Address - Street 1:1 KISH HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:630-936-4029
Practice Address - Fax:630-936-4032
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA00048-G367500000X
IL041.384235367500000X
IL209.384235367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered