Healthcare Provider Details

I. General information

NPI: 1922571397
Provider Name (Legal Business Name): KRISTIN MICHELLE CYRIER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N WALL ST STE P530
KANKAKEE IL
60901-3486
US

IV. Provider business mailing address

375 N WALL ST STE P530
KANKAKEE IL
60901-3486
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-7200
  • Fax: 815-935-7874
Mailing address:
  • Phone: 815-932-7200
  • Fax: 815-935-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041402137
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018875
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: