Healthcare Provider Details

I. General information

NPI: 1730526039
Provider Name (Legal Business Name): VANESSA R VOUDRIE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 3RD ST
BELLEVILLE IL
62220-1915
US

IV. Provider business mailing address

211 S 3RD ST
BELLEVILLE IL
62220-1915
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-6044
  • Fax: 618-222-4636
Mailing address:
  • Phone: 618-234-6044
  • Fax: 618-222-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11010881
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209010402
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: