Healthcare Provider Details

I. General information

NPI: 1306344585
Provider Name (Legal Business Name): MEREDITH P DAVIS MS, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH P GRIESEMER

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-7222
US

IV. Provider business mailing address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-6200
  • Fax:
Mailing address:
  • Phone: 708-216-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209017161
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041402289
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: