Healthcare Provider Details

I. General information

NPI: 1275158990
Provider Name (Legal Business Name): ASHLEY L PERRY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY L MCGRATH

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

PO BOX 3428
SPRINGFIELD IL
62708-3428
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3000
  • Fax: 217-757-2021
Mailing address:
  • Phone: 217-588-2624
  • Fax: 217-757-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209021376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: