Individual
RICK CORBETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 343-0048
(618) 343-0048
Mailing address
500 ANDRA DR, MARYVILLE, IL 62062-5796
(618) 343-0048
(618) 343-0048
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
209002579
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
28184077A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000946369
ANTHEM PROVIDER NUMBER
IN
05
—
200938570
—
IN
Enumeration date
12/14/2005
Last updated
12/21/2015
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