Provider Demographics
NPI:1609089424
Name:DOUGLAS, CYNTHIA R (FNP-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WASHINGTON ST
Mailing Address - Street 2:110 MCCOMAS HALL- VA TECH
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24061-0001
Mailing Address - Country:US
Mailing Address - Phone:540-231-6569
Mailing Address - Fax:540-231-6900
Practice Address - Street 1:WASHINGTON ST
Practice Address - Street 2:110 MCCOMAS HALL- VA TECH
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-0001
Practice Address - Country:US
Practice Address - Phone:540-231-6569
Practice Address - Fax:540-231-6900
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024058343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024058343OtherNP LICENSE NUMBER