Healthcare Provider Details

I. General information

NPI: 1437044518
Provider Name (Legal Business Name): LORI FRANCES LYNN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR
BELLEVILLE IL
62226-5399
US

IV. Provider business mailing address

3236 JOEL DR
SWANSEA IL
62226-2432
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7750
  • Fax:
Mailing address:
  • Phone: 618-973-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209032713
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: