Healthcare Provider Details

I. General information

NPI: 1205286747
Provider Name (Legal Business Name): SHIRLENE UMALI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 SOUTH CRAWFORD AVE
OLYMPIA FIELDS IL
60461
US

IV. Provider business mailing address

20201 SOUTH CRAWFORD AVE
OLYMPIA FIELDS IL
60461
US

V. Phone/Fax

Practice location:
  • Phone: 954-298-2506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.440413
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number106587
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: