Healthcare Provider Details

I. General information

NPI: 1194364364
Provider Name (Legal Business Name): KATIE ELAINE RAGSDALE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ELAINE RAGSDALE CRNA

II. Dates (important events)

Enumeration Date: 01/05/2020
Last Update Date: 01/05/2020
Certification Date: 01/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5493
US

IV. Provider business mailing address

1531 W ROSEMONT AVE
CHICAGO IL
60660-1358
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-6400
  • Fax:
Mailing address:
  • Phone: 773-680-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number125555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: