Healthcare Provider Details

I. General information

NPI: 1932448990
Provider Name (Legal Business Name): REBECCA J SEFTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA J LESTER CRNA

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date: 11/04/2019
Reactivation Date: 04/27/2020

III. Provider practice location address

650 W TAYLOR ST
VANDALIA IL
62471-1227
US

IV. Provider business mailing address

650 W TAYLOR ST
VANDALIA IL
62471-1227
US

V. Phone/Fax

Practice location:
  • Phone: 618-283-1231
  • Fax: 618-283-9977
Mailing address:
  • Phone: 618-283-1231
  • Fax: 618-283-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209010218
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: