Healthcare Provider Details

I. General information

NPI: 1487309175
Provider Name (Legal Business Name): SAWYER CALEB HENDERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W NORTH AVE
MELROSE PARK IL
60160-1612
US

IV. Provider business mailing address

730 N MILWAUKEE AVE APT 1805
CHICAGO IL
60642-6032
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-3200
  • Fax:
Mailing address:
  • Phone: 641-856-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209025584
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28299372A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041461580
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: