1619112406 NPI number — CYNTHIA D HARTLEY PA-C

Table of content: CYNTHIA D HARTLEY PA-C (NPI 1619112406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619112406 NPI number — CYNTHIA D HARTLEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTLEY
Provider First Name:
CYNTHIA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1619112406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9609 LAKE MIST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX STATION
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22039-2677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-635-6886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6895 E HAMPDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80224-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-861-7878
Provider Business Practice Location Address Fax Number:
303-894-8066
Provider Enumeration Date:
12/08/2008

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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