Provider Demographics
NPI:1225069073
Name:KAUFMAN, CINDY CORSIN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:CORSIN
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, PMHNP
Mailing Address - Street 1:84284 DERBYSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9433
Mailing Address - Country:US
Mailing Address - Phone:541-682-7508
Mailing Address - Fax:541-682-3276
Practice Address - Street 1:2411 MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5824
Practice Address - Country:US
Practice Address - Phone:541-682-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR79042496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR261578Medicare ID - Type Unspecified