Provider Demographics
NPI:1326032608
Name:BOHUN, CYNTHIA L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:BOHUN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 RUTH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4323
Mailing Address - Country:US
Mailing Address - Phone:651-735-0501
Mailing Address - Fax:651-735-1870
Practice Address - Street 1:1925 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2270
Practice Address - Country:US
Practice Address - Phone:651-735-0501
Practice Address - Fax:651-735-1870
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN244613L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004854Medicare ID - Type Unspecified