Provider Demographics
NPI:1447248430
Name:FELDMAN-HUBER, JILL R (CRNA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:FELDMAN-HUBER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:800 EAST CARPENTER STREET
Mailing Address - Street 2:ROOM 2K64
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-0001
Mailing Address - Country:US
Mailing Address - Phone:217-525-5643
Mailing Address - Fax:217-544-2521
Practice Address - Street 1:800 EAST CARPENTER STREET
Practice Address - Street 2:ROOM 2K64
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-525-5643
Practice Address - Fax:217-544-2521
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041137845367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL031806OtherCHAMPUS/TRICARE
IL041137845OtherIL LICENSE #
IL209-005615OtherIL APN LICENSE #
IL0841504038OtherBCBS OF ILLINOIS
IL031301OtherHEALTH ALLIANCE NUMBERS
IL37586OtherAANA#
ILL031806OtherCHAMPUS/TRICARE
IL209-005615OtherIL APN LICENSE #
IL031301OtherHEALTH ALLIANCE NUMBERS
IL430003859Medicare ID - Type UnspecifiedMCARERR
IL37586OtherAANA#
IL1285290Medicare ID - Type UnspecifiedMEDICARE UMWA GROUP NUMBE