Individual
CELINA MCINTYRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 N. WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4056
(630) 933-4057
Mailing address
25 N. WINFIELD RD, WINFIELD, IL 60190-1295
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209010803
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041348576
MEDICAID
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400128139
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
11/01/2013
Last updated
07/28/2014
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