Provider Demographics
NPI:1407040835
Name:SCOTT, CYNTHIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 RICHMOND PARK W APT 614B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-4812
Mailing Address - Country:US
Mailing Address - Phone:440-460-0957
Mailing Address - Fax:
Practice Address - Street 1:1042 HILLSTONE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2426
Practice Address - Country:US
Practice Address - Phone:216-291-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 111664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667421Medicaid