Provider Demographics
NPI:1578566337
Name:SANFORD, CYNTHIA NEOMA (MS,ARNP,C-PNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NEOMA
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MS,ARNP,C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7520
Mailing Address - Country:US
Mailing Address - Phone:918-423-4900
Mailing Address - Fax:918-423-4905
Practice Address - Street 1:101 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7520
Practice Address - Country:US
Practice Address - Phone:918-423-4900
Practice Address - Fax:918-423-4905
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062969363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200018840BMedicaid