1548206899 NPI number — CYNTHIA G STOCKDALE CRNP

Table of content: CYNTHIA G STOCKDALE CRNP (NPI 1548206899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548206899 NPI number — CYNTHIA G STOCKDALE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKDALE
Provider First Name:
CYNTHIA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548206899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 NORTH FRANKLIN DRIVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-225-6500
Provider Business Mailing Address Fax Number:
724-225-8188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 NORTH FRANKLIN DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-225-6500
Provider Business Practice Location Address Fax Number:
724-225-8188
Provider Enumeration Date:
06/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LC0200X , with the licence number:  0351192 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2100X , with the licence number: SP006343M , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)