Provider Demographics
NPI:1366941007
Name:NATHAN, CYNTHIA RENE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENE
Last Name:NATHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 SE PENGUIN LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9583
Mailing Address - Country:US
Mailing Address - Phone:360-895-0486
Mailing Address - Fax:
Practice Address - Street 1:3306 SE PENGUIN LN
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9583
Practice Address - Country:US
Practice Address - Phone:360-895-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60094839163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care