Provider Demographics
NPI:1831617174
Name:TSELONIS, PAULINE KENNETH BORJA (DNP, CRNA)
Entity type:Individual
Prefix:DR
First Name:PAULINE KENNETH
Middle Name:BORJA
Last Name:TSELONIS
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:PAULINE KENNETH
Other - Middle Name:CRUZ
Other - Last Name:BORJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6660 W WOOD RIVER DR APT 211
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041363309163W00000X
IL209016992367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse