Provider Demographics
NPI:1003134305
Name:CHRISTIE, CYNTHIA DIANNE (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANNE
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 MCCAMIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9007
Mailing Address - Country:US
Mailing Address - Phone:315-708-7734
Mailing Address - Fax:
Practice Address - Street 1:8080 MCCAMIDGE DR
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9007
Practice Address - Country:US
Practice Address - Phone:315-708-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622007-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse