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General NPI Number Information
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NPI Number | 1417567546
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Entity Type | Individual
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Provider Name | CYNTHIA LYNN RUSNAK
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Gender | Female
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 10735 S CICERO AVE STE 100
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City | OAK LAWN
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State | IL
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Zip | 60453-6210
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Country | US
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Telephone | 708-636-2211
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Fax | 708-636-5552
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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Fax | 847-390-4757
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209021605
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209021605
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277003363
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License Number State | IL
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