Healthcare Provider Details

I. General information

NPI: 1508077389
Provider Name (Legal Business Name): HOWARD LINDECKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DR
MATTOON IL
61938-9253
US

IV. Provider business mailing address

1352 NORTH COUNTY RD. 2000 EAST
CHARLESTON IL
61920-6726
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2440
  • Fax:
Mailing address:
  • Phone: 217-345-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: