Individual
MRS. CYNTHIA LOUISE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
UIC, IJR, 1747 WEST ROOSEVELT ROAD, M/C 747, CU 113, CHICAGO, IL 60608
(312) 413-1136
(312) 413-4459
Mailing address
UIC, IJR, 1747 WEST ROOSEVELT ROAD, M/C 747, CU 113, CHICAGO, IL 60608
(312) 413-1136
(312) 413-4459
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
209000709
IL
Other
Enumeration date
01/14/2009
Last updated
01/14/2009
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