Provider Demographics
NPI:1881023224
Name:VANDEMARK, CYNTHIA L (MSN, WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:VANDEMARK
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1992
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:1250 RALSTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-5310
Practice Address - Country:US
Practice Address - Phone:419-782-5774
Practice Address - Fax:419-782-6103
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-284906-COA-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0095549Medicaid
OH0095549Medicaid