Provider Demographics
NPI:1912707381
Name:ALLEN, CICELY (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CICELY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3076
Mailing Address - Country:US
Mailing Address - Phone:708-830-7354
Mailing Address - Fax:
Practice Address - Street 1:6548 S DREXEL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-4206
Practice Address - Country:US
Practice Address - Phone:708-830-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH541674163WH0200X
IL041573861163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health