Healthcare Provider Details

I. General information

NPI: 1396024931
Provider Name (Legal Business Name): CARRI ANN GRENNAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2011
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

2740 W FOSTER AVE STE 310
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax: 773-293-8804
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.008958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: