Healthcare Provider Details

I. General information

NPI: 1124164629
Provider Name (Legal Business Name): NORMAN EUGENE HOWE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S MARSHALL AVE
MC LEANSBORO IL
62859-1213
US

IV. Provider business mailing address

303 SUNSET DR
MC LEANSBORO IL
62859-1243
US

V. Phone/Fax

Practice location:
  • Phone: 618-643-2361
  • Fax:
Mailing address:
  • Phone: 618-643-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: