Provider Demographics
NPI:1578216198
Name:VARISCO, CYNTHIA ELLEN
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:VARISCO
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 1:14628 BRETON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1211
Mailing Address - Country:US
Mailing Address - Phone:225-892-0372
Mailing Address - Fax:
Practice Address - Street 1:14628 BRETON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1211
Practice Address - Country:US
Practice Address - Phone:225-892-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54272163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management