Healthcare Provider Details

I. General information

NPI: 1619889151
Provider Name (Legal Business Name): ISABELLA CHRISTINE GAJARDO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

11059 W ELMWOOD CT
MOKENA IL
60448-9265
US

V. Phone/Fax

Practice location:
  • Phone: 888-352-7874
  • Fax:
Mailing address:
  • Phone: 708-921-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number233633
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: