1326023854 NPI number — CYNTHIA L KEYFAUVER CRNA

Table of content: CYNTHIA L KEYFAUVER CRNA (NPI 1326023854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326023854 NPI number — CYNTHIA L KEYFAUVER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEYFAUVER
Provider First Name:
CYNTHIA
Provider Middle Name:
L
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:
KEYFAUVER
Provider Other First Name:
CINDY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326023854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1022 BLUE SPRUCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-2860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-349-4983
Provider Business Mailing Address Fax Number:
303-349-4983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 HOFFMAN DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-667-9794
Provider Business Practice Location Address Fax Number:
970-663-6336
Provider Enumeration Date:
12/07/2005

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:  557148 , 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: 127868 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42088062 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 542927-1 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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