Provider Demographics
NPI:1710974852
Name:BRACE, CYNTHIA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:BRACE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1916
Mailing Address - Country:US
Mailing Address - Phone:607-732-7707
Mailing Address - Fax:
Practice Address - Street 1:114 DESMOND ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2084
Practice Address - Country:US
Practice Address - Phone:570-882-7401
Practice Address - Fax:570-882-7404
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301065-1363LA2200X
PASP012069363LA2200X
PARN635076163W00000X
NY414889163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP83051Medicare UPIN
NYDD4684Medicare ID - Type Unspecified