Healthcare Provider Details

I. General information

NPI: 1235515909
Provider Name (Legal Business Name): LISA R ARFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

PO BOX 6350
CHICAGO IL
60680-6350
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041366223
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: