Provider Demographics
NPI:1174688956
Name:RUSSELL-MCCLAIN, CYNTHIA ELLEN (NP, PA-C)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:RUSSELL-MCCLAIN
Suffix:
Gender:F
Credentials:NP, PA-C
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Mailing Address - Street 1:17621 CUNHA LN
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-1528
Mailing Address - Country:US
Mailing Address - Phone:831-754-1544
Mailing Address - Fax:831-754-2984
Practice Address - Street 1:23 UPPER RAGSDALE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7849
Practice Address - Country:US
Practice Address - Phone:831-375-3577
Practice Address - Fax:831-375-1478
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14098363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15145ZOtherMEDICARE ID
CAGR0091130OtherMEDI-CAL
CAGR0091130OtherMEDI-CAL