Healthcare Provider Details

I. General information

NPI: 1528065596
Provider Name (Legal Business Name): MARIA L VANBEBBER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N MAPLE ST
EFFINGHAM IL
62401-2005
US

IV. Provider business mailing address

9250 RHEA PARK RD
LOAMI IL
62661-3174
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-1586
  • Fax:
Mailing address:
  • Phone: 217-414-4068
  • Fax: 217-624-6641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209000891
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: