Provider Demographics
NPI:1053368316
Name:CHAFFIN, CINDY (NP)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:CHAFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61501
Mailing Address - Country:US
Mailing Address - Phone:309-329-2926
Mailing Address - Fax:309-329-2656
Practice Address - Street 1:135 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:IL
Practice Address - Zip Code:61501
Practice Address - Country:US
Practice Address - Phone:309-329-2926
Practice Address - Fax:309-329-2656
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041285438OtherREGISTERED PROF NURSE
IL209002741OtherLIC. ADVANCE P N