Healthcare Provider Details

I. General information

NPI: 1598751182
Provider Name (Legal Business Name): VICTOR A AHLBERG CRNA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W HARLEM AVE
MONMOUTH IL
61462-1007
US

IV. Provider business mailing address

1000 W HARLEM AVE
MONMOUTH IL
61462-1007
US

V. Phone/Fax

Practice location:
  • Phone: 309-734-3141
  • Fax: 309-734-3029
Mailing address:
  • Phone: 309-734-3141
  • Fax: 309-734-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41223386
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: