Healthcare Provider Details

I. General information

NPI: 1992332407
Provider Name (Legal Business Name): LAUREN CHRISTINE RYCZEK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVE
CHICAGO IL
60631-3707
US

IV. Provider business mailing address

1500 S WASHINGTON AVE
PARK RIDGE IL
60068-5439
US

V. Phone/Fax

Practice location:
  • Phone: 847-578-3000
  • Fax:
Mailing address:
  • Phone: 773-899-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209021554
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: