Provider Demographics
NPI:1992051056
Name:PENN, EMILY T (CRNA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:T
Last Name:PENN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:S
Other - Last Name:TANHEHCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - Street 2:2361 PAYSPHERE CIRCLE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:
Practice Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - Street 2:2520 ELISHA AVENUE
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041373674367500000X
IL209.010199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered