Individual
MS. STACI L AMERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
35 ALBANY RD, SUITE C, CARBONDALE, IL 62903-7646
(618) 457-5111
(618) 457-6560
Mailing address
35 ALBANY RD, SUITE C, CARBONDALE, IL 62903-7646
(618) 457-5111
(618) 457-6560
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209008633
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209008633
APN CRNA LICENSE
IL
Enumeration date
02/10/2011
Last updated
12/15/2011
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