Provider Demographics
NPI:1386145258
Name:BERTOLINO, CINDY LEE (NP)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LEE
Last Name:BERTOLINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9142 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:IL
Mailing Address - Zip Code:62069-2334
Mailing Address - Country:US
Mailing Address - Phone:217-556-5806
Mailing Address - Fax:
Practice Address - Street 1:9142 PROSPECT RD
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:IL
Practice Address - Zip Code:62069-2334
Practice Address - Country:US
Practice Address - Phone:217-556-5806
Practice Address - Fax:217-556-5806
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF02180041363LF0000X
IL209.017490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily