Healthcare Provider Details

I. General information

NPI: 1457789034
Provider Name (Legal Business Name): CYNTHIA DENDRINOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725W HARRISON ST 309
CHICAGO IL
60612-3844
US

IV. Provider business mailing address

1725W HARRISON ST 309
CHICAGO IL
60612-3844
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8011
  • Fax: 312-942-2253
Mailing address:
  • Phone: 312-942-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209-011457
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: