Provider Demographics
NPI:1235858762
Name:MATUSZEWSKI, KYLE (CRNA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MATUSZEWSKI
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 1:6617 EICH DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-5202
Mailing Address - Country:US
Mailing Address - Phone:815-263-3113
Mailing Address - Fax:
Practice Address - Street 1:6617 EICH DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-5202
Practice Address - Country:US
Practice Address - Phone:815-263-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041443436163W00000X
IL209029943367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse