Healthcare Provider Details

I. General information

NPI: 1922414986
Provider Name (Legal Business Name): LAURA GAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST FEINBERG 5-704
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

420 E OHIO ST 3F
CHICAGO IL
60611-3390
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4146
  • Fax:
Mailing address:
  • Phone: 202-841-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.011620
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: