Provider Demographics
NPI:1427193424
Name:YORK-CAMDEN, CYNTHIA L (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:YORK-CAMDEN
Suffix:
Gender:F
Credentials:MS, RD, LDN
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 192
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-0192
Mailing Address - Country:US
Mailing Address - Phone:618-542-1005
Mailing Address - Fax:618-542-4756
Practice Address - Street 1:1032 W INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-3949
Practice Address - Country:US
Practice Address - Phone:618-967-9535
Practice Address - Fax:618-565-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003061133V00000X, 133V00000X
MO2011005968282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200989Medicare PIN