Provider Demographics
NPI:1205593290
Name:HARBOR ANESTHESIA PLLC
Entity type:Organization
Organization Name:HARBOR ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLIN-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:574-253-1827
Mailing Address - Street 1:P.O. BOX 736317
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-6317
Mailing Address - Country:US
Mailing Address - Phone:574-253-1827
Mailing Address - Fax:
Practice Address - Street 1:4226 N KOLMAR AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1900
Practice Address - Country:US
Practice Address - Phone:574-253-1827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty