Provider Demographics
NPI:1881023216
Name:DIETZ, CYNTHIA (RN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-2161
Mailing Address - Country:US
Mailing Address - Phone:570-275-4962
Mailing Address - Fax:
Practice Address - Street 1:603 E MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-2161
Practice Address - Country:US
Practice Address - Phone:570-275-4962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN226315L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse