Provider Demographics
NPI:1730481763
Name:SOUTHERLAND, CINDY CHENG-JA (RN, ANP, GNP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:CHENG-JA
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:RN, ANP, GNP
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:CHENG-JA
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ANP, GNP
Mailing Address - Street 1:DUMC
Mailing Address - Street 2:047 BAKER HOUSE, TRENT DRIVE, BOX 3624
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-668-2447
Mailing Address - Fax:919-613-6329
Practice Address - Street 1:DUMC BRAIN TUMOR CTR
Practice Address - Street 2:047 BAKER HOUSE, TRENT DRIVE
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-668-2447
Practice Address - Fax:919-613-6329
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner