Provider Demographics
NPI:1245983113
Name:DILL, COLE J (CRNA)
Entity type:Individual
Prefix:MR
First Name:COLE
Middle Name:J
Last Name:DILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:6742 N FROSTWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2402
Mailing Address - Country:US
Mailing Address - Phone:309-692-5393
Mailing Address - Fax:309-683-9998
Practice Address - Street 1:6742 N FROSTWOOD PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2402
Practice Address - Country:US
Practice Address - Phone:309-692-5393
Practice Address - Fax:309-683-9998
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209024751367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered