Provider Demographics
NPI:1285192914
Name:MYASEIN, KELSEY (MSN, APRN)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:MYASEIN
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N RANDALL RD STE AIP
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2300
Mailing Address - Country:US
Mailing Address - Phone:224-783-2173
Mailing Address - Fax:
Practice Address - Street 1:1900 OGDEN AVE STE 202
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4283
Practice Address - Country:US
Practice Address - Phone:306-405-0713
Practice Address - Fax:708-346-3287
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021037363LF0000X, 363LA2100X
IL041421523163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine