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General NPI Number Information
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NPI Number | 1306149554
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Entity Type | Individual
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Provider Name | MATTHEW DARRELL SPRAYBERRY CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 259 E ERIE ST
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-695-0665
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N. LAKE SHORE DRIVE
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City | CHICAGO
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State | IL
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Zip | 60611-2987
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Country | US
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Telephone | 312-695-6868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.478201
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 223941
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 223941
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209.019297
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License Number State | IL
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