Individual
PETER JAMES GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3000
Mailing address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209.019507
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.421645
RN LICENSE
IL
Enumeration date
07/16/2019
Last updated
07/16/2019
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