1174013353 NPI number — DR. CYNTHIA BARTLETT EDMUNDS DACM, LAC.

Table of content: DR. CYNTHIA BARTLETT EDMUNDS DACM, LAC. (NPI 1174013353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174013353 NPI number — DR. CYNTHIA BARTLETT EDMUNDS DACM, LAC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDMUNDS
Provider First Name:
CYNTHIA
Provider Middle Name:
BARTLETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DACM, LAC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARTLETT
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174013353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1916 S GLENBURNIE RD STE 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-5226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-497-2975
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1916 S GLENBURNIE RD STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-5226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-497-2975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2018

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: 171100000X , with the licence number:  LAC-878 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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