Healthcare Provider Details

I. General information

NPI: 1972699452
Provider Name (Legal Business Name): MOLLY KATHERINE RAVENSCRAFT-EVANS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY K. EVANS

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BROADWAY ST
QUINCY IL
62301-3713
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6550
  • Fax:
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-277-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209002458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: