Individual
TYSON PURCHATZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
Mailing address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209012422
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041377248
—
IL
Enumeration date
01/12/2015
Last updated
01/12/2015
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