Healthcare Provider Details

I. General information

NPI: 1427167238
Provider Name (Legal Business Name): LINDA PASSINI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 E BROADWAY ST
SPARTA IL
62286-1820
US

IV. Provider business mailing address

818 E BROADWAY ST
SPARTA IL
62286-1820
US

V. Phone/Fax

Practice location:
  • Phone: 618-443-2177
  • Fax: 618-443-1382
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209006445
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: