Healthcare Provider Details

I. General information

NPI: 1619251980
Provider Name (Legal Business Name): ANNE T SCRANTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 22ND ST SUITE 610
OAK BROOK IL
60523-2006
US

IV. Provider business mailing address

3998 FAIR RIDGE DRIVE SUITE 300
FAIRFAX VA
22033-2921
US

V. Phone/Fax

Practice location:
  • Phone: 630-537-1720
  • Fax: 847-615-2858
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209-009187
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209009187
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041284579
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: