Provider Demographics
NPI:1417955386
Name:PEIFFER, CYNTHIA A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:PEIFFER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:MORITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151534367500000X
TXAP128162367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0755928Medicaid
MI104335154OtherMICHIGAN MEDICAID
OH430052131OtherRAILROAD MEDICARE
OH8203215Medicare ID - Type UnspecifiedOHIO MEDICARE
OH8203213Medicare ID - Type UnspecifiedOHIO MEDICARE
OH0755928Medicaid