Provider Demographics
NPI:1639797525
Name:CRNA STAT INC
Entity Type:Organization
Organization Name:CRNA STAT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, MS
Authorized Official - Phone:312-394-0222
Mailing Address - Street 1:4534 S LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4510
Mailing Address - Country:US
Mailing Address - Phone:312-394-0222
Mailing Address - Fax:
Practice Address - Street 1:4534 S LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4510
Practice Address - Country:US
Practice Address - Phone:312-394-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty