Provider Demographics
NPI:1457640153
Name:KYLE, CYNTHIA JO (RN, CHPN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JO
Last Name:KYLE
Suffix:
Gender:F
Credentials:RN, CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 LITTLE LEAGUE DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-1232
Mailing Address - Country:US
Mailing Address - Phone:937-456-1828
Mailing Address - Fax:
Practice Address - Street 1:508 LITTLE LEAGUE DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1232
Practice Address - Country:US
Practice Address - Phone:937-456-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN259019163W00000X
IN28143679A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse