Healthcare Provider Details

I. General information

NPI: 1053915553
Provider Name (Legal Business Name): CYNTHIA D MORRIS APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA D GRANT

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W 95TH ST
EVERGREEN PARK IL
60805-2735
US

IV. Provider business mailing address

2850 W 95TH ST
EVERGREEN PARK IL
60805-2735
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-5065
  • Fax: 708-422-6664
Mailing address:
  • Phone: 708-229-5065
  • Fax: 709-422-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.022838
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022838
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041.305933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: