Provider Demographics
NPI:1619238268
Name:BEVAN, CYNTHIA A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:BEVAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 ROMBACH AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1995
Mailing Address - Country:US
Mailing Address - Phone:937-283-9910
Mailing Address - Fax:
Practice Address - Street 1:12459 US HIGHWAY 22 AND 3
Practice Address - Street 2:
Practice Address - City:SABINA
Practice Address - State:OH
Practice Address - Zip Code:45169-9083
Practice Address - Country:US
Practice Address - Phone:937-584-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13345-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily