Healthcare Provider Details

I. General information

NPI: 1689172512
Provider Name (Legal Business Name): CARMEL SANTOS SPARACIO APN-CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 09/20/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

2650 RIDGE AVE. SUITE #1223
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5625
  • Fax:
Mailing address:
  • Phone: 475-702-7608
  • Fax: 847-570-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209017400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: