Basic Information
| Provider Information | |||||||||
| NPI: | 1598792376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEARSALL | ||||||||
| FirstName: | CLARENCE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1977 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627051977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175446464 | ||||||||
| FaxNumber: | 2177576021 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N ALLEN ST | ||||||||
| Address2: | CRAWFORD MEMORIAL HOSPITAL | ||||||||
| City: | ROBINSON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624541167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185462410 | ||||||||
| FaxNumber: | 6185462613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00042144 | 01 | IL | RR MEDICARE PIN | OTHER | 01732004 | 01 | IL | BLUE CROSS/BLUE SHIELD | OTHER | DA2630 | 01 | IL | RR MEDICARE GRP# | OTHER | 542903 | 01 | IL | HEALTHLINK | OTHER |