Healthcare Provider Details

I. General information

NPI: 1437289568
Provider Name (Legal Business Name): KATHLEEN R. STEAR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N HAMMES AVE
JOLIET IL
60435-8114
US

IV. Provider business mailing address

5511 N OSCEOLA AVE
CHICAGO IL
60656-1750
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-0095
  • Fax:
Mailing address:
  • Phone: 773-631-6685
  • Fax:

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: