MICHELLE LIDVALL

PEORIA, IL
NPI1659789410
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: IL  209.011831)
Additional Taxonomies163W00000X Registered Nurse
(Licence: IL  041385084)
Enumeration Date2014-07-24
Last Update Date2014-12-29
Business Address
-- MICHELLE LIDVALL CRNA
221 NE GLEN OAK AVE
PEORIA, IL 61636-0001
Phone number: 309-672-5522
Mailing Address
-- MICHELLE LIDVALL CRNA
221 NE GLEN OAK AVE
PEORIA, IL 61636-0001
Phone number: 309-672-5522