Individual
MARY M. DAMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3303
(217) 383-3265
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209005925
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041298740
IL LICENSE #
IL
01
—
0841504038
BCBS OF ILLINOIS
IL
01
—
209-005925
IL APN LICENSE #
IL
01
—
L031806
CHAMPUS/TRICARE
IL
Enumeration date
10/12/2005
Last updated
04/12/2021
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