Individual
JASON KOBLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1302 FRANKLIN AVE, NORMAL, IL 61761-3551
(309) 268-5867
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801-2500
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209007642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE
IL
Enumeration date
06/09/2009
Last updated
12/06/2024
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