Individual
JASON KISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3881 E CAMELOT CIR APT 302, DECATUR, IL 62526-2078
(219) 765-7400
Mailing address
3881 E CAMELOT CIR APT 302, DECATUR, IL 62526-2078
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
89219
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041350231
ILLINOIS RN LICENSE
IL
01
—
89219
CRNA LICENSE
IL
Enumeration date
07/05/2012
Last updated
07/05/2012
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