1750395414 NPI number — CYNTHIA F LAYTON CRNA

Table of content: CYNTHIA F LAYTON CRNA (NPI 1750395414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750395414 NPI number — CYNTHIA F LAYTON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAYTON
Provider First Name:
CYNTHIA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1750395414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 S 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28401-6443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-763-4555
Provider Business Mailing Address Fax Number:
910-798-8923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 CANTERWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-294-9833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

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: 367500000X , with the licence number:  1017 , 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)

  • Identifier: 430033113 . This is a "MEDICARE RR PROVIDER NO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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