Provider Demographics
NPI:1003877861
Name:GAITHER, JANET L (CRNA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:GAITHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 E LAKE SHORE DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3380
Mailing Address - Country:US
Mailing Address - Phone:217-428-7596
Mailing Address - Fax:217-788-7071
Practice Address - Street 1:899 E LAKE SHORE DR APT 2C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3380
Practice Address - Country:US
Practice Address - Phone:217-428-7596
Practice Address - Fax:217-788-7071
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
042096OtherCCNA CERTIFICATION
042096OtherCCNA CERTIFICATION