Individual
MS. CYNTHIA ROWLEY-SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
104 W 18TH AVE, COAL VALLEY, IL 61240-9337
(309) 799-7518
(309) 799-3886
Mailing address
104 W 18TH AVE, COAL VALLEY, IL 61240-9337
(309) 799-7518
(309) 799-3886
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639142458
—
IL
01
—
362739299001
TRICARE NUMBER
IL
01
—
93342
BCWELLMARK NUMBER
IL
01
—
IL01W4
JOHN DEERE NUMBER
IL
Enumeration date
02/10/2006
Last updated
01/15/2014
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