Provider Demographics
NPI:1174057269
Name:AL-KHENAIZI, CHELSI E (CRNA)
Entity type:Individual
Prefix:
First Name:CHELSI
Middle Name:E
Last Name:AL-KHENAIZI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHELSI
Other - Middle Name:E
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:
Practice Address - Street 1:8600 STATE ROUTE 91 STE 250
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7831
Practice Address - Country:US
Practice Address - Phone:309-692-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015862367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered