Healthcare Provider Details

I. General information

NPI: 1356494660
Provider Name (Legal Business Name): IRMA MENDEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST FEINBERG 5-704
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST FEINBERG 5-704
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-9797
  • Fax: 312-695-0050
Mailing address:
  • Phone: 312-695-9797
  • Fax: 312-695-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-283079
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209-005451
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: