MEDICARE: MISS MAI ULZIIBAYAR WILHOUR CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209008995	IL
2	363LF0000X	Family Nurse Practitioner	209008995	IL

General Provider Information

NPI Number	:	1912285024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MAI ULZIIBAYAR WILHOUR CRNA

Provider Business Mailing Address
First Line	:	1302 FRANKLIN AVE
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-3551
Country	:	US
Telephone Number	:	309-268-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 FRANKLIN AVE
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-3551
Country	:	US
Telephone Number	:	309-268-5867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	06/10/2026

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