Individual
TRACY L. PETERSON
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
041269645
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209005309
IL
Other
Enumeration date
10/13/2005
Last updated
12/21/2020
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