Provider Demographics
NPI:1104014026
Name:CYNTHIA KUDJI LLC
Entity Type:Organization
Organization Name:CYNTHIA KUDJI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUDJI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:504-782-9456
Mailing Address - Street 1:3924 RED CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5815
Mailing Address - Country:US
Mailing Address - Phone:504-782-9456
Mailing Address - Fax:
Practice Address - Street 1:3924 RED CYPRESS DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5815
Practice Address - Country:US
Practice Address - Phone:504-782-9456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1458473Medicaid