Individual
NICOLE SORAYA NOUWAIRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2202 HARLEM ROAD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 636-6125
Mailing address
2202 HARLEM ROAD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 636-6125
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209013378
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173674601
—
TX
01
—
85154U
BLUE CROSS PROVIDER ID
TX
01
—
P00225343
RAILROAD MEDICARE
—
Enumeration date
11/29/2006
Last updated
12/05/2019
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