Healthcare Provider Details

I. General information

NPI: 1417287129
Provider Name (Legal Business Name): CATHLEEN S JOHNSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE
CHICAGO IL
60625-3645
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 Number209007894
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: