Healthcare Provider Details

I. General information

NPI: 1528207081
Provider Name (Legal Business Name): ELIZABETH ANDERSON STEWART CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KISH HOSPITAL DRIVE
DEKALB IL
60115-9602
US

IV. Provider business mailing address

1 KISH HOSPITAL DRIVE
DEKALB IL
60115-9602
US

V. Phone/Fax

Practice location:
  • Phone: 630-936-4029
  • Fax: 630-936-4032
Mailing address:
  • Phone: 630-936-4029
  • Fax: 630-936-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA00048-G
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041.384235
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.384235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: