Provider Demographics
NPI:1497724694
Name:BERTHOLD, CINDY L (CNP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:BERTHOLD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 TALL TIMBERS CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9638
Mailing Address - Country:US
Mailing Address - Phone:614-496-6491
Mailing Address - Fax:614-279-7337
Practice Address - Street 1:2127 TALL TIMBERS CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9638
Practice Address - Country:US
Practice Address - Phone:614-496-6491
Practice Address - Fax:614-279-7337
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488553Medicaid
OH000000546027OtherANTHEM BLUE CROSS BLUE SHIELD
OHNP15774Medicare PIN
OHP00480917Medicare PIN
OHNP15773Medicare PIN
OHQ18097Medicare UPIN