Individual
JUSTIN D CRAFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901
(618) 549-0721
Mailing address
35 ALBANY RD STE C, CARBONDALE, IL 62903-7647
(618) 457-5111
(618) 457-6560
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209007473
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2090074373
CRNA LICENSE
IL
Enumeration date
02/05/2009
Last updated
07/17/2018
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