Provider Demographics
NPI:1760591770
Name:ARON, CATHY J (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:J
Last Name:ARON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:J
Other - Last Name:BOALS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2202 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-654-5342
Practice Address - Street 1:2202 HARLEM RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2754
Practice Address - Country:US
Practice Address - Phone:815-877-4848
Practice Address - Fax:815-654-5342
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041178537163W00000X
IL209-001100367500000X
IL209001100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
430062724OtherRAILROAD MEDICARE
R18369Medicare UPIN
IL593490/L83042Medicare ID - Type Unspecified