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General NPI Number Information
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NPI Number | 1841502549
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Entity Type | Individual
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Provider Name | AIMEE SHANE CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 1051 W SOUTH ST
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City | KEWANEE
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State | IL
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Zip | 61443-8354
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Country | US
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Telephone | 309-852-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 278 PIN OAK CT
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City | DAHINDA
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State | IL
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Zip | 61428-9769
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Country | US
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Telephone | 309-339-1259
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209.008194
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License Number State | IL
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