MEDICARE: CYNTHIA R CAINE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71000102A	IN
2	363LF0000X	Family Nurse Practitioner	209006990	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00058964	OTHER	IN	TRAVELERS MCR PROVIDER #

General Provider Information

NPI Number	:	1215936315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA R CAINE FNP

Provider Business Mailing Address
First Line	:	11200 W LINCOLN HWY
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-8208
Country	:	US
Telephone Number	:	708-873-0062
Fax Number	:	708-873-1820

Provider Business Practice Location Address
First Line	:	11200 W LINCOLN HWY
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-8208
Country	:	US
Telephone Number	:	708-873-0062
Fax Number	:	708-873-1820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	01/20/2011

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