Provider Demographics
NPI:1164498143
Name:PARENT, CYNTHIA M
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:PARENT
Suffix:
Gender:F
Credentials:
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 3794
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-3794
Mailing Address - Country:US
Mailing Address - Phone:907-262-5335
Mailing Address - Fax:
Practice Address - Street 1:1915 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6602
Practice Address - Country:US
Practice Address - Phone:907-223-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN356760L367500000X
AK199367500000X
ID524367500000X
KS55330367500000X
WA30006426367500000X
CA3367367500000X
HI948367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3367OtherCRNA
ID524OtherCRNA
HI59912OtherRN
WA148628OtherRN
ID31029OtherRN
CA450756OtherRN
AK199OtherNURSE ANESTHETIST NO.
AK49857OtherAANA NO.
AK19189OtherRN LICENSE NO.
KS55330OtherCRNA
PA356760LOtherRN AND CRNA
WA30006426OtherCRNA
KS93137OtherRN
HI948OtherCRNA
WAG8870241Medicare PIN