Provider Demographics
NPI:1841201902
Name:KUMRA, MARILYN D (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:D
Last Name:KUMRA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 TIMBER HILL RD.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089
Mailing Address - Country:US
Mailing Address - Phone:847-947-7311
Mailing Address - Fax:
Practice Address - Street 1:236 TIMBER HILL RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1927
Practice Address - Country:US
Practice Address - Phone:847-947-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041221986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041221986Medicaid
IL041221986Medicaid