Healthcare Provider Details

I. General information

NPI: 1669809885
Provider Name (Legal Business Name): GINA L OUSHANA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E. HURON ST. FEINBERG 5-704
CHICAGO IL
60611
US

IV. Provider business mailing address

251 E. HURON ST. FEINBERG 5-704
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 708-650-0705
  • Fax:
Mailing address:
  • Phone: 708-650-0705
  • Fax: 708-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209011127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: