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General NPI Number Information
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NPI Number | 1841249000
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Entity Type | Individual
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Provider Name | KISHA YOUNG CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 09/08/2017
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Provider Practice Location Address
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Address Line | 901 MACARTHUR BLVD
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City | MUNSTER
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State | IN
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Zip | 46321-2901
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Country | US
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Telephone | 219-836-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 570
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City | LAKE FOREST
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State | IL
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Zip | 60045-0570
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Country | US
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Telephone | 847-615-2200
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209002097
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License Number State | IL
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