Healthcare Provider Details

I. General information

NPI: 1528025046
Provider Name (Legal Business Name): CECELIA YVETTE THURMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 LAKEVIEW PKWY 116
VERNON HILLS IL
60061-1857
US

IV. Provider business mailing address

565 LAKEVIEW PKWY SUITE 116
VERNON HILLS IL
60061-1857
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-7340
  • Fax: 847-247-2840
Mailing address:
  • Phone: 847-367-7340
  • Fax: 847-247-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085001035
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: