Basic Information
| Provider Information | |||||||||
| NPI: | 1134426018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 155 | ||||||||
| Address2: | |||||||||
| City: | CHRISTOPHER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628220155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6187242436 | ||||||||
| FaxNumber: | 6187242571 | ||||||||
| Practice Location | |||||||||
| Address1: | 607 4TH ST | ||||||||
| Address2: | |||||||||
| City: | ELDORADO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629301278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182732951 | ||||||||
| FaxNumber: | 6182732712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2011 | ||||||||
| LastUpdateDate: | 02/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 043066652 | IL | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.