Provider Demographics
NPI:1952579518
Name:WHITE ANESTHESIA, LLC
Entity Type:Organization
Organization Name:WHITE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIJUNELIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:224-234-8677
Mailing Address - Street 1:2108 KENTON LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1500
Mailing Address - Country:US
Mailing Address - Phone:224-234-8677
Mailing Address - Fax:
Practice Address - Street 1:2108 KENTON LN
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1500
Practice Address - Country:US
Practice Address - Phone:224-234-8677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty