Healthcare Provider Details

I. General information

NPI: 1659557916
Provider Name (Legal Business Name): KATHERINE A COLINO C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY JELKE 739
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

2551 W SUNNYSIDE AVE #3
CHICAGO IL
60625-3036
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6504
  • Fax: 312-942-8858
Mailing address:
  • Phone: 773-539-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209006932
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: