Healthcare Provider Details

I. General information

NPI: 1538557129
Provider Name (Legal Business Name): LAUREN SMITH IRWIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

1934 W DIVERSEY PKWY UNIT 3
CHICAGO IL
60614-1014
US

V. Phone/Fax

Practice location:
  • Phone: 122-227-4000
  • Fax:
Mailing address:
  • Phone: 330-835-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.012217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: