Provider Demographics
NPI:1093766966
Name:NEUHOFF, KIP (CRNA)
Entity type:Individual
Prefix:MR
First Name:KIP
Middle Name:
Last Name:NEUHOFF
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 1:6742 N FROSTWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2402
Mailing Address - Country:US
Mailing Address - Phone:309-655-4809
Mailing Address - Fax:
Practice Address - Street 1:6742 N FROSTWOOD PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2402
Practice Address - Country:US
Practice Address - Phone:309-655-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023149367500000X
TN11353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN051688OtherAANA
TNRN0000101550OtherTN LICENSE