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General NPI Number Information
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NPI Number | 1760467773
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Entity Type | Individual
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Provider Name | KRAIG A MITCHELL C.R.N.A.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 530 PARK AVE E STE 201
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City | PRINCETON
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State | IL
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Zip | 61356-2598
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Country | US
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Telephone | 815-875-2811
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Fax |
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Provider Business Mailing Address
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Address Line | 530 PARK AVE E
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City | PRINCETON
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State | IL
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Zip | 61356-2598
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Country | US
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Telephone | 815-780-4040
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Fax | 815-780-1940
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 142331-030
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209-003881
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License Number State | IL
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