Provider Demographics
NPI:1710265335
Name:WREN, CYNTHIA GARRETT
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GARRETT
Last Name:WREN
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 1:12 COUNTY ROAD 110
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7570
Mailing Address - Country:US
Mailing Address - Phone:662-415-6690
Mailing Address - Fax:866-491-3128
Practice Address - Street 1:12 COUNTY ROAD 110
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7570
Practice Address - Country:US
Practice Address - Phone:662-415-6690
Practice Address - Fax:866-491-3128
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP304593164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse