Provider Demographics
NPI:1396841631
Name:PERRY, CYNTHIA K (PHD, FNP)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:K
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:K
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3727 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:PLANNED PARENTHOOD OF THE COLUMBIA WILLAMETTE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1112
Mailing Address - Country:US
Mailing Address - Phone:503-775-4931
Mailing Address - Fax:503-788-7285
Practice Address - Street 1:3727 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:PLANNED PARENTHOOD OF THE COLUMBIA WILLAMETTE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1112
Practice Address - Country:US
Practice Address - Phone:503-775-4931
Practice Address - Fax:503-788-7285
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00162005163W00000X
WAAP30007125363L00000X
OR090007382N1363LF0000X
OR090007382RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR61445Medicaid
WA9651787Medicaid