Individual
MR. DEREK J HUMPHRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6742 N FROSTWOOD PKWY, PEORIA, IL 61615-2402
(309) 692-5393
(309) 683-9998
Mailing address
128 JUSTICE DR, EAST PEORIA, IL 61611-1468
(309) 369-1543
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209025607
IL
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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