Provider Demographics
NPI:1972000438
Name:KASI, ELVIS (CRNA)
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:
Last Name:KASI
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 1:2553 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:IA
Mailing Address - Zip Code:52645-9197
Mailing Address - Country:US
Mailing Address - Phone:319-594-7903
Mailing Address - Fax:
Practice Address - Street 1:8201 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-2300
Practice Address - Country:US
Practice Address - Phone:815-971-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD167554367500000X
IL209.024897367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered