Healthcare Provider Details

I. General information

NPI: 1306564521
Provider Name (Legal Business Name): LINDSAY RENEE WAYNE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 10/09/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST # 3200W
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

2408 THAXTON CT
NAPERVILLE IL
60565-4010
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 630-470-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041431563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: