Healthcare Provider Details

I. General information

NPI: 1578180733
Provider Name (Legal Business Name): ERIK CISNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E WINTER AVE
DANVILLE IL
61832-2295
US

IV. Provider business mailing address

113 W 7TH ST
VEEDERSBURG IN
47987-1108
US

V. Phone/Fax

Practice location:
  • Phone: 217-651-6801
  • Fax:
Mailing address:
  • Phone: 217-649-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: