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General NPI Number Information
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NPI Number | 1477935112
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Entity Type | Individual
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Provider Name | ANNMARIE BACH CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 08/24/2015
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Provider Practice Location 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 | 708-326-1671
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Fax |
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Provider Business Mailing Address
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Address Line | 2831 RYAN DR
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City | NEW LENOX
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State | IL
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Zip | 60451-2633
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Country | US
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Telephone | 815-717-6621
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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 | 28211331A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041310711
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209013115
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License Number State | IL
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