Provider Demographics
NPI:1760880900
Name:MACALUSO, DANA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:CANDELARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1722 W DIVERSEY PKWY
Mailing Address - Street 2:UNIT 2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1010
Mailing Address - Country:US
Mailing Address - Phone:773-972-0047
Mailing Address - Fax:
Practice Address - Street 1:701 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1612
Practice Address - Country:US
Practice Address - Phone:708-681-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012281367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered