Provider Demographics
NPI:1396828497
Name:FLICK, CYNTHIA FAYE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:FAYE
Last Name:FLICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:667 EASTLAND AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4503
Practice Address - Country:US
Practice Address - Phone:330-841-4100
Practice Address - Fax:330-841-4455
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN300614-COA1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2701473Medicaid