Provider Demographics
NPI:1912411265
Name:CARTWRIGHT, MARK (DNP-CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CARTWRIGHT
Suffix:
Gender:M
Credentials:DNP-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 N WAYNE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1308
Mailing Address - Country:US
Mailing Address - Phone:773-790-8291
Mailing Address - Fax:
Practice Address - Street 1:1969 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3765
Practice Address - Country:US
Practice Address - Phone:312-864-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered