Provider Demographics
NPI:1528247640
Name:WEBB, MICHELLE RENEE (CRNA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:WEBB
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:600 S 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4936
Mailing Address - Country:US
Mailing Address - Phone:309-353-0406
Mailing Address - Fax:309-347-1240
Practice Address - Street 1:600 S 13TH STREET
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-353-0406
Practice Address - Fax:309-347-1240
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041233059367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL614451Medicare PIN