Provider Demographics
NPI:1437525060
Name:ELLER, CYNTHIA RANDALL (NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RANDALL
Last Name:ELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:ELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1900 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3563
Mailing Address - Country:US
Mailing Address - Phone:336-903-6840
Mailing Address - Fax:336-903-6841
Practice Address - Street 1:1900 W PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3563
Practice Address - Country:US
Practice Address - Phone:336-903-6840
Practice Address - Fax:336-903-6841
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC139373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner