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CICERO OFFEMARIA BERMUNDO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
620 WARRINGTON AVE, DANVILLE, IL 61832-5446
(217) 446-0660
Mailing address
511 LAWNDALE DR, DANVILLE, IL 61832-2244

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
043112534
IL
225200000X
Physical Therapy Assistant
Primary
160.007924
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
145183
IL
Enumeration date
02/20/2018
Last updated
02/20/2018
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