Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Souphaphone Bounmythavong Nicksic, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1740425701

Souphaphone Bounmythavong Nicksic, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Elgin, Illinois. Qualified in 2009, 17 years ago. Practices with Advocate Health and Hospitals Corporation, a 3,079-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Illinois and Indiana.

Years since qualifying
17
Licensed in
IL, IN
In the registry since
2008
Specialties on file
2
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

See every abbreviation used in this directory →

Practice location Address checks out

1425 N Randall Rd
Elgin, IL 60123-2300
Phone: (224) 783-1065
Fax: (224) 783-2852
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 2475 Dean St, Saint Charles, IL 60175-4831 — (630) 584-9800
  • 2600 Greenbush St, Lafayette, IN 47904-2477 — (765) 448-8000

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 209008677 (IL)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 28181986A (IN)

Record details

NPI number1740425701
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNA
Sole proprietorNo
NPI enumeratedDecember 4, 2008
Last updated in NPPESAugust 30, 2023
Certification dateAugust 30, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Advocate Health And Hospitals Corporation — 3079 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Elgin