Active NPI
Phyllis Wubben, CRNA
- Certified Registered Nurse Anesthetist
- Mokena, IL
National Provider Identifier
1861747594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 209-002368
- Practice address
- 19627 La Grange Rd
Attention: Southwest Anesthesia Consultants
Mokena, IL 60448-9360 - Phone
- (708) 326-1630
- Fax
- (708) 326-1671
- NPI assigned
- Jul 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 209-002368 | IL | Primary |
Addresses
Primary practice location
19627 La Grange Rd
Attention: Southwest Anesthesia Consultants
Mokena, IL 60448-9360
Mailing address
19627 Lagrange Road
Attention: Southwest Anesthesia Consultants
Mokena, IL 60448
Phone (708) 326-1630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-002368 | IL | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342569600000",
"number": "1861747594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19627 LAGRANGE ROAD",
"address_2": "ATTENTION: SOUTHWEST ANESTHESIA CONSULTANTS",
"city": "MOKENA",
"state": "IL",
"postal_code": "60448",
"telephone_number": "708-326-1630",
"fax_number": "708-326-1671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19627 LA GRANGE RD",
"address_2": "ATTENTION: SOUTHWEST ANESTHESIA CONSULTANTS",
"city": "MOKENA",
"state": "IL",
"postal_code": "604489360",
"telephone_number": "708-326-1630",
"fax_number": "708-326-1671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WUBBEN",
"first_name": "PHYLLIS",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-18",
"last_updated": "2012-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": "209-002368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mokena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.