Provider Demographics
NPI:1194775957
Name:VILLASENOR, CHRISTIAN Q (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:Q
Last Name:VILLASENOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35777 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1357
Mailing Address - Country:US
Mailing Address - Phone:708-503-1637
Mailing Address - Fax:708-326-1671
Practice Address - Street 1:20201 S CRAWFORD AVENUE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1010
Practice Address - Country:US
Practice Address - Phone:708-326-1637
Practice Address - Fax:708-326-1671
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99015186A174400000X
IL209004510367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist