Basic Information
| Provider Information | |||||||||
| NPI: | 1144252891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNDEEN | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 E SPRINGFIELD AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618205462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173550926 | ||||||||
| FaxNumber: | 2173551801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 W PARK ST STE A | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173374310 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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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 | 363LP0808X | 20-9003408 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.