Provider Demographics
NPI:1811381346
Name:FEUTZ, CYNTHIA ELLEN (ACNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:FEUTZ
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:ELLEN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:DC 034.00, C4037
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-882-8499
Mailing Address - Fax:573-884-0316
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:DC 034.00, C4037
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-1000
Practice Address - Country:US
Practice Address - Phone:573-882-8499
Practice Address - Fax:573-884-0316
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO071569364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health