Healthcare Provider Details

I. General information

NPI: 1578574869
Provider Name (Legal Business Name): JAMIE NORTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE HAWKINS CRNA

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N LOGAN AVE
DANVILLE IL
61832-3752
US

IV. Provider business mailing address

PO BOX 532904
ATLANTA GA
30353-2904
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-5000
  • Fax:
Mailing address:
  • Phone: 217-443-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209004937
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: