Provider Demographics
NPI:1114517265
Name:CRAIN, EMMY GAEL
Entity Type:Individual
Prefix:
First Name:EMMY
Middle Name:GAEL
Last Name:CRAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-2802
Mailing Address - Country:US
Mailing Address - Phone:618-203-5882
Mailing Address - Fax:
Practice Address - Street 1:920 N 11TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-2802
Practice Address - Country:US
Practice Address - Phone:618-203-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043129609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL043129609OtherILLINOIS DEPARTMENT OF FEDERAL AND PROFESSIONAL REGULATION