Healthcare Provider Details

I. General information

NPI: 1386553626
Provider Name (Legal Business Name): THEA RANEE CYR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N KANSAS ST
EDWARDSVILLE IL
62025-1735
US

IV. Provider business mailing address

7004 AUGUSTA DR
GLEN CARBON IL
62034-3030
US

V. Phone/Fax

Practice location:
  • Phone: 618-656-5167
  • Fax:
Mailing address:
  • Phone: 618-267-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number041452404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: