Provider Demographics
NPI:1528025046
Name:THURMAN, CECELIA YVETTE (PA)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:YVETTE
Last Name:THURMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1857
Mailing Address - Country:US
Mailing Address - Phone:847-367-7340
Mailing Address - Fax:847-247-2840
Practice Address - Street 1:565 LAKEVIEW PKWY
Practice Address - Street 2:116
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1857
Practice Address - Country:US
Practice Address - Phone:847-367-7340
Practice Address - Fax:847-247-2840
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q675553Medicare UPIN