Healthcare Provider Details

I. General information

NPI: 1760628457
Provider Name (Legal Business Name): CURTIS L. BAKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST ROOM 2K64
SPRINGFIELD IL
62769-0001
US

IV. Provider business mailing address

800 E CARPENTER ST ROOM 2K64
SPRINGFIELD IL
62769-0001
US

V. Phone/Fax

Practice location:
  • Phone: 217-525-5643
  • Fax: 217-544-2521
Mailing address:
  • Phone: 217-525-5643
  • Fax: 217-544-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041311481
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209007475
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: