Provider Demographics
NPI:1770667081
Name:FITZGERALD, CYNTHIA RYDZEWSKI (CRNA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RYDZEWSKI
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50794
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0794
Mailing Address - Country:US
Mailing Address - Phone:702-228-0781
Mailing Address - Fax:702-933-4460
Practice Address - Street 1:2615 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0450
Practice Address - Country:US
Practice Address - Phone:702-228-0781
Practice Address - Fax:702-933-4460
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCRNA000185367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV104079Medicare PIN