Provider Demographics
NPI:1932448990
Name:SEFTON, REBECCA J (CRNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:SEFTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:650 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1227
Mailing Address - Country:US
Mailing Address - Phone:618-283-1231
Mailing Address - Fax:618-283-9977
Practice Address - Street 1:650 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1227
Practice Address - Country:US
Practice Address - Phone:618-283-1231
Practice Address - Fax:618-283-9977
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2020-04-27
Deactivation Date:2019-11-04
Deactivation Code:
Reactivation Date:2020-04-27
Provider Licenses
StateLicense IDTaxonomies
IL209010218367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered