Healthcare Provider Details

I. General information

NPI: 1033413695
Provider Name (Legal Business Name): SHARON F. RYAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST CHICAGO
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE#1000
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4387
  • Fax:
Mailing address:
  • Phone: 312-695-9797
  • Fax: 312-695-6594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209008564
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: