1447565353 NPI number — MRS. MICHELLE LEIGH SWITZER CRNA

Table of content: MRS. MICHELLE LEIGH SWITZER CRNA (NPI 1447565353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447565353 NPI number — MRS. MICHELLE LEIGH SWITZER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWITZER
Provider First Name:
MICHELLE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447565353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 NE GLEN OAK AVE
Provider Second Line Business Mailing Address:
ANESTHESIA DEPARTMENT
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61636-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-672-5522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N 1ST ST
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62781-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-788-3754
Provider Business Practice Location Address Fax Number:
217-788-7071
Provider Enumeration Date:
08/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  209008225 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 084078 . This is a "CCNA CERTIFICATION NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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