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Souphaphone Bounmythavong Nicksic, CRNA
Certified Registered Nurse Anesthetist in Elgin, Illinois
NPI 1740425701

Souphaphone Bounmythavong Nicksic is a Certified Registered Nurse Anesthetist based in Chicago, IL. Souphaphone Bounmythavong Nicksic practices in Elgin, IL and has the professional credentials of CRNA. The NPI Number for Souphaphone Bounmythavong Nicksic is 1740425701 and holds a License No. 28181986A (Illinois).

The current practice location address for Souphaphone Bounmythavong Nicksic is 1425 N Randall Rd, Elgin, IL and can be reached out via phone at 224-783-1065 and via fax at 224-783-2852. You can also correspond with Souphaphone Bounmythavong Nicksic through the mailing address at 29373 NETWORK PL, CHICAGO, IL - 60673-1293 (mailing address contact number: 847-390-5900).

Location: 1425 N Randall Rd, Elgin, IL, 60673-1293
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1740425701
Provider Name
Souphaphone Bounmythavong Nicksic
Credential
CRNA
Provider Entity Type
Individual
Gender
Female
Address
1425 N Randall Rd, Elgin, IL, 60673-1293
Phone Number
224-783-1065
Fax Number
224-783-2852
Provider Enumeration Date
12/04/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
000000610221 01 IN ANTHEM PROVIDER NUMBER
200949460 05 IN
institution
Provider Business Practice Location Address Details
Address
1425 N Randall Rd
City
Elgin
State
Illinois
Zip
60123-2300
Phone Number
224-783-1065
Fax Number
224-783-2852
person
Provider Business Mailing Address Details
Address
1425 N Randall Rd
City
Elgin
State
Illinois
Zip
60123-2300
Phone Number
224-783-1065
Fax Number
224-783-2852
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Anesthetist, Certified Registered
Speciality
-
Taxonomy
367500000X
License No.
28181986A (Indiana)
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
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