Provider Demographics
NPI:1619996592
Name:GREYWOLF, CYNTHIA T (DNP-PMHNP,BC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:T
Last Name:GREYWOLF
Suffix:
Gender:F
Credentials:DNP-PMHNP,BC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP-PMHNP, BC
Mailing Address - Street 1:901 W ALAMEDA ST STE 25
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1673
Mailing Address - Country:US
Mailing Address - Phone:505-988-8869
Mailing Address - Fax:505-982-6298
Practice Address - Street 1:901 W ALAMEDA ST STE 25
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501
Practice Address - Country:US
Practice Address - Phone:505-988-8869
Practice Address - Fax:505-982-6298
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03198363LP0808X
MA227608364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4807Medicare ID - Type Unspecified