MEDICARE: ELIZABETH EGGEMEYER 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	209010246	IL

General Provider Information

NPI Number	:	1528401809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH EGGEMEYER CRNA

Provider Business Mailing Address
First Line	:	2 GOOD SAMARITAN WAY
Second Line	:	STE 205
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2476
Country	:	US
Telephone Number	:	618-899-3869
Fax Number	:	618-899-3558

Provider Business Practice Location Address
First Line	:	2 GOOD SAMARITAN WAY
Second Line	:	STE 205
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2476
Country	:	US
Telephone Number	:	618-899-3869
Fax Number	:	618-899-3558

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	06/01/2021

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