Healthcare Provider Details

I. General information

NPI: 1417177627
Provider Name (Legal Business Name): CHRISTINE ANN SALVATOR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR ANESTHESIOLOGY DEPT.
HARVEY IL
60426-3558
US

IV. Provider business mailing address

6701 N. BOSWORTH AVE. UNIT 2 B
CHICAGO IL
60626
US

V. Phone/Fax

Practice location:
  • Phone: 708-333-2300
  • Fax:
Mailing address:
  • Phone: 773-320-2667
  • Fax: 773-761-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: