Provider Demographics
NPI:1548266620
Name:BEAR, CYNTHIA ANN (PA)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:BEAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15730
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61132-5730
Mailing Address - Country:US
Mailing Address - Phone:815-864-3333
Mailing Address - Fax:815-864-3331
Practice Address - Street 1:2300 N ROCKTON AVE
Practice Address - Street 2:STE 304
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3619
Practice Address - Country:US
Practice Address - Phone:815-964-3333
Practice Address - Fax:815-964-3331
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL194269OtherPERSONAL CARE
ILK05879Medicare PIN
IL194269OtherPERSONAL CARE