Healthcare Provider Details

I. General information

NPI: 1306090360
Provider Name (Legal Business Name): TANJA ZEBIC CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST FEINBERG 5-704
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST FEINBERG 5-704
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-6855
  • Fax: 312-695-6848
Mailing address:
  • Phone: 312-926-6855
  • Fax: 312-695-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28161514A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209007346
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: