Provider Demographics
NPI:1033396494
Name:PENTZ, CYNTHIA JANE (PA-C, EDD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JANE
Last Name:PENTZ
Suffix:
Gender:F
Credentials:PA-C, EDD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:JANE
Other - Last Name:THORSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:MERCURY
Mailing Address - State:NV
Mailing Address - Zip Code:89023
Mailing Address - Country:US
Mailing Address - Phone:702-295-6224
Mailing Address - Fax:702-295-6047
Practice Address - Street 1:BUSTER STREET, BUILDING 650
Practice Address - Street 2:NATIONAL SECURITY TECHNOLOGIES, LLC
Practice Address - City:MERCURY
Practice Address - State:NV
Practice Address - Zip Code:89023
Practice Address - Country:US
Practice Address - Phone:702-295-6224
Practice Address - Fax:702-295-6047
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant