1043750540 NPI number — GINA SAAL APRN, CRNA

Table of content: GINA SAAL APRN, CRNA (NPI 1043750540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043750540 NPI number — GINA SAAL APRN, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAAL
Provider First Name:
GINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRAKSLER
Provider Other First Name:
GINA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043750540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12251 S 80TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60463-1290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-923-3936
Provider Business Mailing Address Fax Number:
708-923-8848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12251 S 80TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-923-3936
Provider Business Practice Location Address Fax Number:
708-923-8848
Provider Enumeration Date:
03/02/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  209015663 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)