Provider Demographics
NPI:1992385546
Name:SPRINGER, PATRICK (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15753 SUMNER CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:IL
Mailing Address - Zip Code:60541-9226
Mailing Address - Country:US
Mailing Address - Phone:815-212-0608
Mailing Address - Fax:
Practice Address - Street 1:925 WEST ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2757
Practice Address - Country:US
Practice Address - Phone:815-223-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023533367500000X
IL135162367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty