Healthcare Provider Details

I. General information

NPI: 1346334828
Provider Name (Legal Business Name): MRS. BETH FORIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH MCCARTNEY CRNA

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S. MARYLAND AVENUE
CHICAGO IL
60637
US

IV. Provider business mailing address

828 8TH AVENUE
LAGRANGE IL
60525
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 708-579-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: