Provider Demographics
NPI:1366784233
Name:MACKEY, CYNTHIA S (CNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:MACKEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23250 CHAGRIN BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5419
Mailing Address - Country:US
Mailing Address - Phone:216-312-4687
Mailing Address - Fax:
Practice Address - Street 1:23250 CHAGRIN BLVD STE 450
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5419
Practice Address - Country:US
Practice Address - Phone:216-312-4687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP14407363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
H188390Medicare PIN