Basic Information
| Provider Information | |||||||||
| NPI: | 1295800266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NKANA | ||||||||
| FirstName: | CYNTHIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 532904 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303532904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174435000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 812 N LOGAN AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618323752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174435000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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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 | 207L00000X | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 9232012 | 01 | IL | BCBS | OTHER | P00025691 | 01 | IL | RR MEDICARE | OTHER | DA4244 | 01 | IL | RR MEDICARE GROUP | OTHER | 36064339 | 05 | IL | MEDICAID |