Individual
TYLER JACOB MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-4644
(217) 258-2440
(217) 258-2186
Mailing address
PO BOX 372, MATTOON, IL 61938-0372
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041460929
IL
367500000X
Certified Registered Nurse Anesthetist
2021040417
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
209023442
IL
Other
Enumeration date
03/03/2021
Last updated
04/16/2024
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