Healthcare Provider Details

I. General information

NPI: 1578406831
Provider Name (Legal Business Name): CHANDRA CRAVENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E COURT ST
PARIS IL
61944-2460
US

IV. Provider business mailing address

602 SHAW AVE
PARIS IL
61944-2354
US

V. Phone/Fax

Practice location:
  • Phone: 217-465-4141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041549145
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: