Provider Demographics
NPI:1891720140
Name:HUSKE, THERESE M (CRNA)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:HUSKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:M
Other - Last Name:HARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1740 W TAYLOR ST
Mailing Address - Street 2:3200W, MC515
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7232
Mailing Address - Country:US
Mailing Address - Phone:312-996-4020
Mailing Address - Fax:312-996-4019
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:3200W, MC515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-4020
Practice Address - Fax:312-996-4019
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005893367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23939Medicare ID - Type Unspecified
ILK23940Medicare ID - Type Unspecified