Individual
EMMY GAEL CRAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
920 N 11TH ST, HERRIN, IL 62948-2802
(618) 203-5882
Mailing address
920 N 11TH ST, HERRIN, IL 62948-2802
(618) 203-5882
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043129609
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043129609
ILLINOIS DEPARTMENT OF FEDERAL AND PROFESSIONAL REGULATION
IL
Enumeration date
01/22/2021
Last updated
01/22/2021
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