Individual
EDUARDO J CISNEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 REVERE DR STE 200, NORTHBROOK, IL 60062-8000
(312) 600-3991
(630) 473-2232
Mailing address
4824 N TRIPP AVE, CHICAGO, IL 60630-2721
(312) 320-1971
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
041524344
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209034192
IL
Other
Enumeration date
07/17/2025
Last updated
12/31/2025
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