Healthcare Provider Details

I. General information

NPI: 1205103363
Provider Name (Legal Business Name): EMILIE VERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILIE E VERSON HARTMAN

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. DEPARTMENT OF ANESTHESIA
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2760
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209009244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: