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Individual

MRS. PATARAPORN SRIPRARAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-4613
Mailing address
5000 S 5TH AVE, HINES, IL 60141-3030

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041326050
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209009721
IL
367500000X
Certified Registered Nurse Anesthetist
768915
TX

Other

Enumeration date
08/17/2012
Last updated
02/02/2013
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