Provider Demographics
NPI:1629268628
Name:NIXON, CYNTHIA ANN
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:NIXON
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 1:483 BACKUS RD
Mailing Address - Street 2:
Mailing Address - City:CAYUGA
Mailing Address - State:NY
Mailing Address - Zip Code:13034-2176
Mailing Address - Country:US
Mailing Address - Phone:315-224-1219
Mailing Address - Fax:
Practice Address - Street 1:483 BACKUS RD
Practice Address - Street 2:
Practice Address - City:CAYUGA
Practice Address - State:NY
Practice Address - Zip Code:13034-2176
Practice Address - Country:US
Practice Address - Phone:315-224-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1895721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01925960Medicaid