Healthcare Provider Details

I. General information

NPI: 1518420462
Provider Name (Legal Business Name): PATRICIA A CEDANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 WICKER AVE
SAINT JOHN IN
46373-8878
US

IV. Provider business mailing address

8261 WICKER AVE
SAINT JOHN IN
46373-8878
US

V. Phone/Fax

Practice location:
  • Phone: 218-902-0646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01190775
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: