Provider Demographics
NPI:1154325066
Name:BENZ, CYNTHIA CROCKER (MN APRN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CROCKER
Last Name:BENZ
Suffix:
Gender:F
Credentials:MN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BOIMARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3104
Mailing Address - Country:US
Mailing Address - Phone:504-443-6503
Mailing Address - Fax:504-988-4772
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-1371
Practice Address - Fax:504-988-4772
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN031423 AP01610364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA890001246OtherRAILROAD MEDICARE
MS00126291Medicaid
LA1160440Medicaid
AL891017484Medicaid
LA1160440Medicaid
LA4C461D867Medicare PIN