Healthcare Provider Details

I. General information

NPI: 1467546390
Provider Name (Legal Business Name): KATHRYN ANNE MONTAGUE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN ANNE MONTAGUE CRNA

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RANDALL RD
GENEVA IL
60134-4200
US

IV. Provider business mailing address

300 RANDALL RD
GENEVA IL
60134-4200
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-4050
  • Fax:
Mailing address:
  • Phone: 630-208-4060
  • Fax: 630-208-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number20900165
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: