Provider Demographics
NPI:1548288624
Name:BARNES, LOIS A (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:A
Last Name:BARNES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8419
Mailing Address - Country:US
Mailing Address - Phone:815-385-0084
Mailing Address - Fax:815-385-8968
Practice Address - Street 1:4309 W MEDICAL CENTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8419
Practice Address - Country:US
Practice Address - Phone:815-385-0084
Practice Address - Fax:815-385-8968
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000720367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209068Medicare ID - Type Unspecified