Healthcare Provider Details

I. General information

NPI: 1265472450
Provider Name (Legal Business Name): MARIA DAVIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 S PRAIRIE AVE
CHICAGO IL
60616-3920
US

IV. Provider business mailing address

3350 S PRAIRIE AVE
CHICAGO IL
60616-3920
US

V. Phone/Fax

Practice location:
  • Phone: 312-342-9026
  • Fax:
Mailing address:
  • Phone: 312-342-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209001909
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41290355
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: