MEDICARE: CUMBERLAND COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209005982	IL
2	251K00000X	Public Health or Welfare Agency		IL

General Provider Information

NPI Number	:	1063446938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMBERLAND COUNTY

Provider Business Mailing Address
First Line	:	P.O. BOX 130
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-0130
Country	:	US
Telephone Number	:	217-849-3211
Fax Number	:	217-849-3121

Provider Business Practice Location Address
First Line	:	200 S. INDIANA ST.
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-0130
Country	:	US
Telephone Number	:	217-849-3211
Fax Number	:	217-849-3121

Authorized Official
Title or Position	:	HR MANAGER
Name	:	CYNTHIA DIANE HANLEY
Credential	:
Telephone Number	:	217-849-3211

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/04/2016

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Directions to “CUMBERLAND COUNTY ” Practice Location

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