Souphaphone Bounmythavong Nicksic is a Elgin, Illinois based nurse anesthetist with 16 years of experience as Anesthesia Administration. She completed she graduation in 2009. She accepts the Medicare-approved amount. Patients will not be billed for any more than the Medicare deductible and coinsurance. Active license number of Souphaphone Bounmythavong Nicksic is 209008677 for Anesthesia Administration in Illinois. Her current practice location is 1425 N Randall Rd, Elgin. Patients can reach her at 224-783-1065 or can fax her at 224-783-2852. Souphaphone Bounmythavong Nicksic is CRNA with specialization in Anesthesia Administration and she NPI number (Unique professional ID assigned by NPPES) is 1740425701. Souphaphone Bounmythavong Nicksic is a certified 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.
Complete Profile:
Souphaphone Bounmythavong Nicksic speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
Specialization:
Anesthesia Administration
Credentials:
CRNA
Experience:
16+ years
Medical School Attended:
Other
Graduation Year:
2009
Gender:
Female
Accepts Medicare Assignment:
Yes
Practice Address:
1425 N Randall Rd, Elgin, Illinois, 60123-2300
Phone:
224-783-1065
Fax:
224-783-2852
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
PAC ID:
2567517691
Enrollment ID:
I20120323000591
NPI Number:
1740425701
NPI Enumeration Date:
04 Dec, 2008
NPI Last Update On:
30 Aug, 2023
Medical Licenses:
Nurses can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Souphaphone Bounmythavong Nicksic are as mentioned below.
License Number
Specialization
State
Status
209008677
Anesthesia Administration
Illinois
Primary
28181986A
Anesthesia Administration
Indiana
Secondary
Group Practice:
Group practices are run by a group of physicians who share their premises and other resources. Following list states all the group name
with which Souphaphone Bounmythavong Nicksic has association with along with the number of members in that group.
Organization Name (Group PAC ID)
Members
Valley Ambulatory Surgery Center Anesthesia Ltd (0345225116)
10
Other Medical Identifiers:
Other legacy medical identifiers associated with Souphaphone Bounmythavong Nicksic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
000000610221
Other
Indiana
ANTHEM PROVIDER NUMBER
200949460
Medicaid
Indiana
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
29373 Network Pl, Chicago, Illinois
Zip:
60673-1293
Phone Number:
847-390-5900
Fax Number:
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Patients can reach Souphaphone Bounmythavong Nicksic at 1425 N Randall Rd, Elgin, Illinois or can call to book an appointment on 224-783-1065.
Comments/ Reviews:
Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 14 April, 2025.