Individual
PAMELA K. WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 EAST CARPENTER STREET, ROOM 2K64, SPRINGFIELD, IL 62769-0001
(217) 525-5643
(217) 544-2521
Mailing address
800 EAST CARPENTER STREET, ROOM 2K64, SPRINGFIELD, IL 62769-0001
(217) 525-5643
(217) 544-2521
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0041311537
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209000327
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041311537
IL STATE LICENSE #
IL
01
—
055582
HEALTH ALLIANCE NUMBERS
IL
01
—
0841504038
BCBS OF ILLINOIS
IL
01
—
33274
AANA#
IL
Enumeration date
10/13/2005
Last updated
01/19/2024
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