Healthcare Provider Details

I. General information

NPI: 1790098119
Provider Name (Legal Business Name): LEIGH LUCAS-CLAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 N STATE ROUTE 91 SUITE 250
PEORIA IL
61615-9541
US

IV. Provider business mailing address

8600 N STATE ROUTE 91 SUITE 250
PEORIA IL
61615-9541
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-5393
  • Fax: 309-692-2538
Mailing address:
  • Phone: 309-692-5393
  • Fax: 309-692-2538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11018660
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209008207
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: