Healthcare Provider Details

I. General information

NPI: 1184991978
Provider Name (Legal Business Name): ANDREW WORTHINGTON CHASE-ZIOLEK RN, MS, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-5600
  • Fax: 847-535-7884
Mailing address:
  • Phone: 847-234-5600
  • Fax: 847-535-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.009185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: