Provider Demographics
NPI:1558495598
Name:AURORA PROFESSIONAL ANESTHESIA SERVICE
Entity Type:Organization
Organization Name:AURORA PROFESSIONAL ANESTHESIA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:630-910-0753
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003966367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty