Provider Demographics
NPI:1760982805
Name:FARGO, CYNTHIA J
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:FARGO
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 1:878 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3610
Mailing Address - Country:US
Mailing Address - Phone:781-935-1421
Mailing Address - Fax:
Practice Address - Street 1:878 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3610
Practice Address - Country:US
Practice Address - Phone:781-935-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula