MEDICARE: JOAN K. SCHULLIAN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist		IL

General Provider Information

NPI Number	:	1295724110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN K. SCHULLIAN CRNA

Provider Business Mailing Address
First Line	:	35 ALBANY RD
Second Line	:	SUITE C
City	:	CARBONDALE
State	:	IL
Zip	:	62903-7605
Country	:	US
Telephone Number	:	618-457-5111
Fax Number	:	618-457-6560

Provider Business Practice Location Address
First Line	:	510 LINCOLN DR
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-6334
Country	:	US
Telephone Number	:	618-457-5111
Fax Number	:	618-457-6560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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