Individual
RYAN NANKERVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 W JACKSON STREET, DBA SIH MEDICAL GROUP ANESTHESIOLOGY, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0449
Mailing address
405 W JACKSON STREET, DBA SIH MEDICAL GROUP ANESTHESIOLOGY, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0449
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041404827
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209016792
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MULTI SPECIALTY GROUP
IL
Enumeration date
10/01/2017
Last updated
07/17/2019
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