Provider Demographics
NPI:1528065596
Name:VANBEBBER, MARIA L (CRNA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:VANBEBBER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 RHEA PARK RD
Mailing Address - Street 2:
Mailing Address - City:LOAMI
Mailing Address - State:IL
Mailing Address - Zip Code:62661-3174
Mailing Address - Country:US
Mailing Address - Phone:217-414-4068
Mailing Address - Fax:217-624-6641
Practice Address - Street 1:502 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2005
Practice Address - Country:US
Practice Address - Phone:217-347-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000891367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200088790AMedicaid
OK243709202Medicare PIN
OK249622603Medicare PIN
OK000370138001OtherBCBS