Provider Demographics
NPI:1548576945
Name:BRACY, CYNTHIA JUNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JUNE
Last Name:BRACY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:JUNE
Other - Last Name:BRACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:15302 40TH AVE W
Mailing Address - Street 2:2-101
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8971
Mailing Address - Country:US
Mailing Address - Phone:425-773-4892
Mailing Address - Fax:
Practice Address - Street 1:15302 40TH AVE W
Practice Address - Street 2:2-101
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8971
Practice Address - Country:US
Practice Address - Phone:425-773-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00039143164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse