Provider Demographics
NPI:1841407582
Name:LOEBIG, CYNTHIA (DNP, NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LOEBIG
Suffix:
Gender:F
Credentials:DNP, NP
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:J
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1100 W TOWN AND COUNTRY RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4698
Mailing Address - Country:US
Mailing Address - Phone:888-979-2247
Mailing Address - Fax:
Practice Address - Street 1:14040 N CAVE CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6179
Practice Address - Country:US
Practice Address - Phone:602-358-7073
Practice Address - Fax:888-927-0409
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV835543163W00000X
CA14694261QC1500X, 363LF0000X
AZ218564363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ544615Medicaid
CA545893OtherREGISTERED NURSE
CA14694OtherFURNISHING NUMBER
AZ218564OtherAZ PMHNP LICENSE