=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386255974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNPLISTIC WOMEN'S CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2020
-----------------------------------------------------
Last Update Date | 12/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6609 S UNIVERSITY AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60637-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-535-4183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6621
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60680-6605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-535-4183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CYNTHIA JACINTHE
-----------------------------------------------------
Credential | CNM
-----------------------------------------------------
Telephone | 646-535-4183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------