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Individual

CLARENCE L PEARSALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1000 N ALLEN ST, CRAWFORD MEMORIAL HOSPITAL, ROBINSON, IL 62454-1167
(618) 546-2410
(618) 546-2613
Mailing address
PO BOX 1977, SPRINGFIELD, IL 62705-1977
(217) 544-6464
(217) 757-6021

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01732004
BLUE CROSS/BLUE SHIELD
IL
01
542903
HEALTHLINK
IL
01
DA2630
RR MEDICARE GRP#
IL
01
P00042144
RR MEDICARE PIN
IL
Enumeration date
06/27/2006
Last updated
07/09/2007
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