Provider Demographics
NPI:1720703820
Name:TEAGUE, RENIE ARIELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:RENIE
Middle Name:ARIELLE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RENIE
Other - Middle Name:ARIELLE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 SARATOGA LN
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5030
Mailing Address - Country:US
Mailing Address - Phone:815-514-8021
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER CROSS BLVD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9509
Practice Address - Country:US
Practice Address - Phone:815-300-7097
Practice Address - Fax:815-300-3567
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026126367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered