Healthcare Provider Details

I. General information

NPI: 1649134578
Provider Name (Legal Business Name): CATHERINE GRUENWALD APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

306 HARPER CT
NORMAL IL
61761-3215
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone: 309-824-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.454795
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: