Healthcare Provider Details

I. General information

NPI: 1972599546
Provider Name (Legal Business Name): CYNTHIA ANN BUDEK RN, MS, APN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

5009 N MULLIGAN AVE
CHICAGO IL
60630-1810
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax: 312-227-9642
Mailing address:
  • Phone: 773-576-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-000462
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: