Bacom, Cecelia B

Bacom, Cecelia B is an individual health care provider with primary practice located at 6201 Roosevelt Rd , Berwyn IL 60402-1108. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Bacom, Cecelia B can be contacted via phone (708) 386-0845.

Contact Information

Primary practice address
6201 Roosevelt Rd Berwyn IL 60402-1108
Phone: (708) 386-0845
Fax: (708) 386-8472
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 209001981 Illinois

Profile Details

NPI number 1932141637
LBN Legal business name Bacom, Cecelia B
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2006
Last updated Dec 23rd, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932141637 NPPES
Illinois MEDICAID 209001981

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