Provider Demographics
NPI:1821031410
Name:MCCALL, CYNTHIA D (ARNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:MCCALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9730
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:100 3RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9730
Practice Address - Country:US
Practice Address - Phone:509-725-6560
Practice Address - Fax:509-725-1509
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129272163W00000X
WAAP30006479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642299Medicaid
WAP00206807OtherMEDICARE RAILROAD
WA7101132Medicaid
WA7117450Medicaid
WA188210OtherDEPT. OF L & I
WACJ6525OtherMEDICARE RAILROAD
WACJ6525OtherMEDICARE RAILROAD
WA188210OtherDEPT. OF L & I
WAG8807429Medicare PIN
WACJ6525OtherMEDICARE RAILROAD