1902806037 NPI number — MS. CYNTHIA MARIE FELLER CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902806037 NPI number — MS. CYNTHIA MARIE FELLER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELLER
Provider First Name:
CYNTHIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
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:
ELLISON
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
FELLER
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902806037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3172 SPEICHER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEMOORE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93245-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-998-8986
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL HOSPITAL LEMOORE
Provider Second Line Business Practice Location Address:
937 FRANKLIN AVE
Provider Business Practice Location Address City Name:
LEMOORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93246-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-998-4201
Provider Business Practice Location Address Fax Number:
559-998-4682
Provider Enumeration Date:
07/29/2005

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:  308066-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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