Provider Demographics
NPI:1679721633
Name:BOOTH, CYNTHIA L (RN, MS, PCNS-BC)
Entity Type:Individual
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First Name:CYNTHIA
Middle Name:L
Last Name:BOOTH
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Gender:F
Credentials:RN, MS, PCNS-BC
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Mailing Address - Street 1:1919 W TAYLOR ST RM 808
Mailing Address - Street 2:CHILDREN'S HABILITATION CLINIC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7246
Mailing Address - Country:US
Mailing Address - Phone:312-996-1376
Mailing Address - Fax:312-413-3445
Practice Address - Street 1:1801 W TAYLOR ST # 2E
Practice Address - Street 2:CHILDREN AND ADOLESCENT CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4319
Practice Address - Country:US
Practice Address - Phone:312-996-7202
Practice Address - Fax:312-413-3445
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
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Provider Licenses
StateLicense IDTaxonomies
IL041-227271163WP0200X
IL209-007230364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics