Provider Demographics
NPI:1114147758
Name:AUSTIN, CYNTHIA GAIL (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAIL
Last Name:AUSTIN
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:PO BOX 19335
Mailing Address - Street 2:
Mailing Address - City:THORNE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99919-0335
Mailing Address - Country:US
Mailing Address - Phone:907-755-4985
Mailing Address - Fax:907-755-2650
Practice Address - Street 1:7300 KLAWOCK HOLLIS HWY
Practice Address - Street 2:
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925
Practice Address - Country:US
Practice Address - Phone:907-755-4985
Practice Address - Fax:907-755-2350
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24755163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management