MEDICARE: HEIDEMARIE KRAUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	20911986	IL

General Provider Information

NPI Number	:	1215337845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDEMARIE KRAUSE

Provider Business Mailing Address
First Line	:	40 E CHICAGO AVE
Second Line	:	UNIT 356
City	:	CHICAGO
State	:	IL
Zip	:	60611-2026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 E CHICAGO AVE
Second Line	:	UNIT 356
City	:	CHICAGO
State	:	IL
Zip	:	60611-2026
Country	:	US
Telephone Number	:	312-622-0530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	01/02/2015

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