Provider Demographics
NPI:1326045410
Name:MAST, CYNTHIA (PA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1359
Mailing Address - Country:US
Mailing Address - Phone:785-842-4477
Mailing Address - Fax:785-842-7433
Practice Address - Street 1:346 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1359
Practice Address - Country:US
Practice Address - Phone:785-842-4477
Practice Address - Fax:785-842-7433
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant