Provider Demographics
NPI:1942472410
Name:JANICKI, RICHARD G (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:JANICKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18221 TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2870
Mailing Address - Country:US
Mailing Address - Phone:708-895-9450
Mailing Address - Fax:708-895-9455
Practice Address - Street 1:10500 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5205
Practice Address - Country:US
Practice Address - Phone:708-424-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-302333163W00000X
IL209007374367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse