Provider Demographics
NPI:1437846102
Name:WASSMER, CYNTHIA KAY
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:WASSMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EYE
Mailing Address - State:MO
Mailing Address - Zip Code:65611-8299
Mailing Address - Country:US
Mailing Address - Phone:785-220-8633
Mailing Address - Fax:
Practice Address - Street 1:39505 LONESTAR RD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:KS
Practice Address - Zip Code:66026-7666
Practice Address - Country:US
Practice Address - Phone:785-220-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007036685163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse