Provider Demographics
NPI:1841349776
Name:MADEWELL, HOLLI RENEE (CRNA)
Entity type:Individual
Prefix:MISS
First Name:HOLLI
Middle Name:RENEE
Last Name:MADEWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 HIRSCH AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2530
Mailing Address - Country:US
Mailing Address - Phone:708-832-9548
Mailing Address - Fax:
Practice Address - Street 1:465 HIRSCH AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2530
Practice Address - Country:US
Practice Address - Phone:708-832-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006342367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered