Healthcare Provider Details

I. General information

NPI: 1154067858
Provider Name (Legal Business Name): CYNTHIA CAZARES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3046 127TH ST
BLUE ISLAND IL
60406-1827
US

IV. Provider business mailing address

PO BOX 746721
ATLANTA GA
30374-6721
US

V. Phone/Fax

Practice location:
  • Phone: 773-453-6868
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025402
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041405521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: