Healthcare Provider Details

I. General information

NPI: 1215337845
Provider Name (Legal Business Name): HEIDEMARIE KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E CHICAGO AVE UNIT 356
CHICAGO IL
60611-2026
US

IV. Provider business mailing address

40 E CHICAGO AVE UNIT 356
CHICAGO IL
60611-2026
US

V. Phone/Fax

Practice location:
  • Phone: 312-622-0530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number20911986
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: