Provider Demographics
NPI:1467097998
Name:BRECHUM, CYNTHIA ADZO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ADZO
Last Name:BRECHUM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ADZO
Other - Last Name:BRECHUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:6443 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5610
Mailing Address - Country:US
Mailing Address - Phone:773-297-7648
Mailing Address - Fax:
Practice Address - Street 1:6443 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-5610
Practice Address - Country:US
Practice Address - Phone:773-297-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty