Provider Demographics
NPI:1346471539
Name:MARTIN, CYNTHIA SUE (APRN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SUE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:SUE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2200 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622
Mailing Address - Country:US
Mailing Address - Phone:785-221-0802
Mailing Address - Fax:785-350-4525
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622
Practice Address - Country:US
Practice Address - Phone:785-221-0802
Practice Address - Fax:785-350-4525
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74982-121363LF0000X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily