Individual
EILEEN BOETEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
18221 TORRENCE AVE, LANSING, IL 60438-2870
(708) 895-9450
Mailing address
552 FLEETWOOD DR N, VALPARAISO, IN 46385-6806
(219) 929-6982
(219) 464-7221
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
17767330
WI
367500000X
Certified Registered Nurse Anesthetist
209.005883
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
28078166A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000610944
ANTHEM PROVIDER NUMBER
IN
05
—
200542180
—
IN
Enumeration date
05/27/2006
Last updated
05/20/2013
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