Provider Demographics
NPI:1326291840
Name:BRYANT-PETERSON, CINDY (LMP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BRYANT-PETERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18136 154TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6261
Mailing Address - Country:US
Mailing Address - Phone:425-481-6123
Mailing Address - Fax:
Practice Address - Street 1:18136 154TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6261
Practice Address - Country:US
Practice Address - Phone:425-481-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist