Provider Demographics
NPI:1780640698
Name:STRICKLAND, KENNETH J (CRNA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:STRICKLAND
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E WING ST
Mailing Address - Street 2:#182
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6064
Mailing Address - Country:US
Mailing Address - Phone:866-839-7136
Mailing Address - Fax:866-245-7239
Practice Address - Street 1:126 E WING ST
Practice Address - Street 2:#182
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6064
Practice Address - Country:US
Practice Address - Phone:866-839-7136
Practice Address - Fax:866-245-7239
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003040367500000X
IL041250380163W00000X
WI119308030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0001Medicare ID - Type Unspecified
ILL89993Medicare ID - Type Unspecified
ILL89994Medicare ID - Type Unspecified
ILL89992Medicare ID - Type Unspecified