Provider Demographics
NPI:1023397155
Name:INGELS, CYNTHIA R (MSN,NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:INGELS
Suffix:
Gender:F
Credentials:MSN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DOYLE PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4558
Mailing Address - Country:US
Mailing Address - Phone:707-579-1102
Mailing Address - Fax:
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-579-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily