Individual
MRS. MICHELE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
520 S MAPLE AVE, OAK PARK, IL 60304-1022
(708) 660-3500
Mailing address
4616 W 100TH PL, OAK LAWN, IL 60453-4118
(708) 423-3084
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
IL
Other
Enumeration date
03/09/2007
Last updated
02/21/2008
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