Provider Demographics
NPI:1376677187
Name:GOLDSTEIN FELT, TRACEY R (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:R
Last Name:GOLDSTEIN FELT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:R
Other - Last Name:FELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN-CRNA
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:ANESTHESIOLOGY, ROOM 3905
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-570-2760
Practice Address - Fax:847-570-2921
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-320747367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-320747OtherIL STATE LIC