Healthcare Provider Details

I. General information

NPI: 1275444721
Provider Name (Legal Business Name): CYNTHIA MARIA VAICIULIS APRN FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N RIDGE AVE APT 1B
CHICAGO IL
60660-2378
US

IV. Provider business mailing address

6060 N RIDGE AVE APT 1B
CHICAGO IL
60660-2378
US

V. Phone/Fax

Practice location:
  • Phone: 773-220-0027
  • Fax:
Mailing address:
  • Phone: 773-220-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: