Provider Demographics
NPI:1346265352
Name:MULCAHY, CYNTHIA ANN (133N000000X)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:133N000000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 SWEETWATER TRL
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2252
Mailing Address - Country:US
Mailing Address - Phone:307-773-4544
Mailing Address - Fax:307-773-2947
Practice Address - Street 1:6900 ALDEN DR
Practice Address - Street 2:FE WARREN AFB
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82005-3906
Practice Address - Country:US
Practice Address - Phone:307-773-4544
Practice Address - Fax:307-773-2947
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY833486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY067OtherLICENSURE