Provider Demographics
NPI:1568452555
Name:MCGRATH, CYNTHIA A (DNP)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:A
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:ATHERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9951 ROCK CUT XING
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-1999
Mailing Address - Country:US
Mailing Address - Phone:815-639-8500
Mailing Address - Fax:815-639-8501
Practice Address - Street 1:9951 ROCK CUT XING
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-1999
Practice Address - Country:US
Practice Address - Phone:815-639-8500
Practice Address - Fax:815-639-8501
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209001419OtherIL STATE LICENSE
IL309000854OtherIL STATE CTL SUBS LICENSE
ILMM0723393OtherDEA
IL309000854OtherIL STATE CTL SUBS LICENSE
ILS24604Medicare UPIN