Healthcare Provider Details

I. General information

NPI: 1659503472
Provider Name (Legal Business Name): REBECCA L BLAIR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DANVILLE POLYCLINIC, LTD. 707 N LOGAN AVE
DANVILLE IL
61832-4360
US

IV. Provider business mailing address

DANVILLE POLYCLINIC, LTD. 707 N LOGAN AVE
DANVILLE IL
61832-4360
US

V. Phone/Fax

Practice location:
  • Phone: 217-477-4794
  • Fax: 217-477-4757
Mailing address:
  • Phone: 217-477-4794
  • Fax: 217-477-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28238046A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209007449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: