Provider Demographics
NPI:1407160112
Name:KILDARE, CYNTHIA ANN (APRN NP- C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:KILDARE
Suffix:
Gender:F
Credentials:APRN NP- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 FARNAM ST
Mailing Address - Street 2:SUITE 709
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68183-1000
Mailing Address - Country:US
Mailing Address - Phone:402-717-0710
Mailing Address - Fax:402-717-0711
Practice Address - Street 1:1819 FARNAM ST
Practice Address - Street 2:ALEGENT CREIGHTON HEALTH CLINIC
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68183-1000
Practice Address - Country:US
Practice Address - Phone:402-717-0710
Practice Address - Fax:402-717-0711
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025531400Medicaid
NE10025651900Medicaid
NE10025817200Medicaid
NEN/AOtherCOVENTRY
NEN/AOtherMIDLANDS CHOICE
NE10025817200Medicaid