Provider Demographics
NPI:1144252891
Name:SUNDEEN, CINDY RENEE (APN)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:RENEE
Last Name:SUNDEEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E SPRINGFIELD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5462
Mailing Address - Country:US
Mailing Address - Phone:217-355-0926
Mailing Address - Fax:217-355-1801
Practice Address - Street 1:1405 W PARK ST STE A
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2367
Practice Address - Country:US
Practice Address - Phone:217-337-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20-9003408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS89255Medicare UPIN
IL206327Medicare ID - Type Unspecified