Individual
AGATA REJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2202 HARLEM RD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 654-5342
Mailing address
2202 HARLEM RD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 654-5342
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.303894
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209.008240
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00911926
RAILROAD MEDICARE
IL
Enumeration date
07/20/2010
Last updated
06/01/2011
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