Healthcare Provider Details

I. General information

NPI: 1720058357
Provider Name (Legal Business Name): LEVORN MCCAIN-JONES APN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18221 TORRENCE AVE
LANSING IL
60438
US

IV. Provider business mailing address

12545 S EDBROOKE AVE
CHICAGO IL
60628-7505
US

V. Phone/Fax

Practice location:
  • Phone: 708-895-9450
  • Fax:
Mailing address:
  • Phone: 773-568-3559
  • 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: