Healthcare Provider Details

I. General information

NPI: 1316376510
Provider Name (Legal Business Name): KAPILA MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAPILA POTHU

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 FRANKLIN AVE
NORMAL IL
61761-3558
US

IV. Provider business mailing address

1304 FRANKLIN AVE
NORMAL IL
61761-3558
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-1400
  • Fax:
Mailing address:
  • Phone: 309-454-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number156701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: