Provider Demographics
NPI:1326036310
Name:DOWELL, AMY B (CRNA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:DOWELL
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 1:800 E CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-4514
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:
Practice Address - Street 1:800 E CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-4514
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005611367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL031806OtherCHAMPUS/TRICARE
IL209-005611OtherIL APN LICENSE #
IL72797OtherAANA#
IL041302470OtherIL LICENSE #
IL0841504038OtherBLUE CROSS BLUE SHIELD
IL72797OtherAANA#
IL041302470OtherIL LICENSE #
IL1285290Medicare ID - Type UnspecifiedMEDICARE UMWA GROUP #
ILP00251122Medicare ID - Type UnspecifiedMEDICARE RR
ILK20344Medicare ID - Type UnspecifiedMEDICARE PART B
IL794510Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILQ50947Medicare UPIN