Healthcare Provider Details

I. General information

NPI: 1619448461
Provider Name (Legal Business Name): KRISTINA M LACPLESIS DNP-CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JOHN DEERE RD
MOLINE IL
61265-6892
US

IV. Provider business mailing address

6529 TAYLOR DR
WOODRIDGE IL
60517-1320
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-5000
  • Fax:
Mailing address:
  • Phone: 630-776-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041.378298
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209018805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: