Provider Demographics
NPI:1316245053
Name:PREVATKE, CYNTHIA LOUISE (RN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:PREVATKE
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:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-0376
Mailing Address - Country:US
Mailing Address - Phone:630-485-9172
Mailing Address - Fax:630-230-3840
Practice Address - Street 1:2829 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-8041
Practice Address - Country:US
Practice Address - Phone:630-485-9172
Practice Address - Fax:630-230-3840
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041184322163W00000X, 163WC0400X, 163WC1500X, 163WH0200X, 163WH1000X, 163WM0705X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health