Healthcare Provider Details

I. General information

NPI: 1124089669
Provider Name (Legal Business Name): ELISE B ARNOLD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N. 1ST STREET
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

PO BOX 3428
SPRINGFIELD IL
62708-3428
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3755
  • Fax: 217-788-7071
Mailing address:
  • Phone: 217-788-3754
  • Fax: 217-788-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209000855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: