Healthcare Provider Details

I. General information

NPI: 1457961328
Provider Name (Legal Business Name): AMBER LEIGH CAGUNGUN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER LEIGH CRAVEN CRNA

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DR
MATTOON IL
61938-4644
US

IV. Provider business mailing address

912 OAKCREST DR APT F
CHARLESTON IL
61920-1780
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2525
  • Fax:
Mailing address:
  • Phone: 601-513-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2362550
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041.495969
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: