Provider Demographics
NPI:1891941886
Name:CYNTHIA LOVE NYDICK, D.O., P.L.L.C.
Entity Type:Organization
Organization Name:CYNTHIA LOVE NYDICK, D.O., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:NYDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-360-7100
Mailing Address - Street 1:PO BOX 722808
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-9137
Mailing Address - Country:US
Mailing Address - Phone:405-360-7100
Mailing Address - Fax:405-364-9112
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:SUITE 205
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-360-7100
Practice Address - Fax:405-364-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4220208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty