Provider Demographics
NPI:1104564111
Name:GROSS, CINDY KAY (RN)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:KAY
Last Name:GROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 ELDORADO BLACKTOP RD
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:IL
Mailing Address - Zip Code:62979-2121
Mailing Address - Country:US
Mailing Address - Phone:618-313-1954
Mailing Address - Fax:
Practice Address - Street 1:70 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-3390
Practice Address - Country:US
Practice Address - Phone:618-273-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.263219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty