Healthcare Provider Details

I. General information

NPI: 1992051056
Provider Name (Legal Business Name): EMILY T PENN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY S TANHEHCO

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CANCER TREATMENT CENTERS OF AMERICA 2520 ELISHA AVENUE
ZION IL
60099
US

IV. Provider business mailing address

CANCER TREATMENT CENTERS OF AMERICA 2361 PAYSPHERE CIRCLE
CHICAGO IL
60674
US

V. Phone/Fax

Practice location:
  • Phone: 800-322-9183
  • Fax:
Mailing address:
  • Phone: 800-322-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041373674
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.010199
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: