Provider Demographics
NPI:1609205806
Name:NEWMAN, KELSEY A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:A
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:A
Other - Last Name:BUDZOWSKI, BRENNEN, WIECHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2202 HARLEM ROAD
Mailing Address - Street 2:SUITE200
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-636-6125
Practice Address - Street 1:2202 HARLEM ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2754
Practice Address - Country:US
Practice Address - Phone:815-877-4848
Practice Address - Fax:815-636-6125
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-011130367500000X
IL041.357461367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered