Provider Demographics
NPI:1770580946
Name:BUGAJ, THERESE A (APN-CRNA)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:A
Last Name:BUGAJ
Suffix:
Gender:F
Credentials:APN-CRNA
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:BUGAJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1174 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3648
Mailing Address - Country:US
Mailing Address - Phone:847-234-0045
Mailing Address - Fax:
Practice Address - Street 1:18221 TORRENCE AVE
Practice Address - Street 2:SUITE 1-D
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2870
Practice Address - Country:US
Practice Address - Phone:708-895-9450
Practice Address - Fax:847-895-9455
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-144120163W00000X
IL209000530367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse