MEDICARE: BETTY LUSSI MESTOUSIS CRNA, APN

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	363LA2100X	Acute Care Nurse Practitioner	209-006214	IL
2	367500000X	Certified Registered Nurse Anesthetist	209015047	IL

General Provider Information

NPI Number	:	1952522815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY LUSSI MESTOUSIS CRNA, APN

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1000
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-695-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1000
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-695-9797
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	12/18/2025

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