Provider Demographics
NPI:1043703796
Name:AGUILAR, HEIDI L (CRNA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:BORYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3110 W BELLE PLAINE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2461
Mailing Address - Country:US
Mailing Address - Phone:773-329-7190
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL117447367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered