Healthcare Provider Details

I. General information

NPI: 1396828521
Provider Name (Legal Business Name): HARIKLIA K HORWATH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BRUSH HILL RD
ELMHURST IL
60126-5658
US

IV. Provider business mailing address

2160 S FIRST AVE 101 1740 LOYOLA UNIVERSITY MEDICAL CENTER
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-1000
  • Fax:
Mailing address:
  • Phone: 708-216-9000
  • Fax: 708-216-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209506857
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: