Individual
MARY GRACE KASHMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3204
(847) 362-2900
Mailing address
925 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
(847) 615-2200
(847) 615-2858
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041259305
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430014089
RAILROAD MEDICARE
IL
Enumeration date
07/25/2006
Last updated
12/13/2012
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