1164498143 NPI number — CYNTHIA M PARENT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164498143 NPI number — CYNTHIA M PARENT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PARENT

Provider First Name:

CYNTHIA

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

F

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:

1164498143

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 3794

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SOLDOTNA

Provider Business Mailing Address State Name:

AK

Provider Business Mailing Address Postal Code:

99669-3794

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

907-262-5335

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1915 E REZANOF DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

KODIAK

Provider Business Practice Location Address State Name:

AK

Provider Business Practice Location Address Postal Code:

99615-6602

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

907-223-7513

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

02/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  RN356760L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 199 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 367500000X , with the licence number: 524 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 55330 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 30006426 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 3367 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 948 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 3367 . This is a "CRNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 524 . This is a "CRNA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: 59912 . This is a "RN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 148628 . This is a "RN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 31029 . This is a "RN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: 450756 . This is a "RN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 199 . This is a "NURSE ANESTHETIST NO." identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
• Identifier: 49857 . This is a "AANA NO." identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
• Identifier: 19189 . This is a "RN LICENSE NO." identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
• Identifier: 55330 . This is a "CRNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
• Identifier: 356760L . This is a "RN AND CRNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30006426 . This is a "CRNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 93137 . This is a "RN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
• Identifier: 948 . This is a "CRNA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".