Healthcare Provider Details

I. General information

NPI: 1730808270
Provider Name (Legal Business Name): NATALIA P WALAT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E NORRIS DR
OTTAWA IL
61350-1604
US

IV. Provider business mailing address

256 BUTTERNUT LN
STREAMWOOD IL
60107-2258
US

V. Phone/Fax

Practice location:
  • Phone: 815-433-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.462741
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209029822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: