Healthcare Provider Details

I. General information

NPI: 1124245550
Provider Name (Legal Business Name): WILLIAM KENT JANES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST ANESTHESIA DEPARTMENT
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

PO BOX 4488
SPRINGFIELD IL
62708-4488
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3754
  • Fax: 217-788-7071
Mailing address:
  • Phone: 800-577-5368
  • Fax: 217-757-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: