Healthcare Provider Details

I. General information

NPI: 1306562632
Provider Name (Legal Business Name): ALEXIS KRISTEN WONAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS KRISTEN KHOSRAVANI

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. DEPT. OF ANESTHESIOLOGY
EVANSTON IL
60201
US

IV. Provider business mailing address

2650 RIDGE AVE. DEPT. OF ANESTHESIOLOGY
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2921
  • Fax:
Mailing address:
  • Phone: 847-570-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041414842
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209026414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: