Provider Demographics
NPI:1558468975
Name:HENLEY, CINDY A (ADVANCE PRACTICE NUR)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:A
Last Name:HENLEY
Suffix:
Gender:F
Credentials:ADVANCE PRACTICE NUR
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 193
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939-0193
Mailing Address - Country:US
Mailing Address - Phone:618-995-9391
Mailing Address - Fax:
Practice Address - Street 1:1909 W COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-997-5677
Practice Address - Fax:618-997-3627
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002243363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-002243OtherADVANCED PRACTICE NURSE