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General NPI Number Information
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NPI Number | 1033629308
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Entity Type | Individual
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Provider Name | RACHEL ROADRUCK CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1443
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Country | US
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Telephone | 888-824-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 19627 S LA GRANGE RD
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City | MOKENA
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State | IL
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Zip | 60448-9360
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041384661
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209016945
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License Number State | IL
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