Provider Demographics
NPI:1679507917
Name:HENNIGH, CYNTHIA (APRN-BC, CFNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HENNIGH
Suffix:
Gender:F
Credentials:APRN-BC, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 POND WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5581
Mailing Address - Country:US
Mailing Address - Phone:571-542-4950
Mailing Address - Fax:571-285-1160
Practice Address - Street 1:4500 POND WAY
Practice Address - Street 2:SUITE 170
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5581
Practice Address - Country:US
Practice Address - Phone:571-542-4950
Practice Address - Fax:571-285-1160
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679507917Medicaid
VA010374545Medicaid
VAVAA103907Medicare PIN
VA011323V59Medicare PIN
VA010374545Medicaid