MEDICARE: MS. JEANETTE A. DUBAY-MCDERMIT CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209002113	IL

General Provider Information

NPI Number	:	1427052885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANETTE A. DUBAY-MCDERMIT CRNA

Provider Business Mailing Address
First Line	:	3833 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2735
Country	:	US
Telephone Number	:	773-665-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1000
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-926-2280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/08/2016

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