Provider Demographics
NPI:1366195919
Name:HERDA-KEITH, CYNTHIA GAYE (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAYE
Last Name:HERDA-KEITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:G
Other - Last Name:HERDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6942 W OLIVE AVE LOT 70
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7266
Mailing Address - Country:US
Mailing Address - Phone:740-617-7871
Mailing Address - Fax:
Practice Address - Street 1:6942 W OLIVE AVE LOT 70
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7266
Practice Address - Country:US
Practice Address - Phone:740-617-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242933163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse