Healthcare Provider Details

I. General information

NPI: 1720226442
Provider Name (Legal Business Name): PATTI S DURBIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 FRANCISCAN DRIVE ANESTHESIA DEPT
LITCHFIELD IL
62056
US

IV. Provider business mailing address

1215 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-2191
  • Fax:
Mailing address:
  • Phone: 217-324-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209007458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: