Provider Demographics
NPI:1902364912
Name:SURMACZEWICZ, CYNTHIA P (PA-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:P
Last Name:SURMACZEWICZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 W 121ST ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2009
Mailing Address - Country:US
Mailing Address - Phone:913-884-1055
Mailing Address - Fax:913-884-1066
Practice Address - Street 1:7011 W 121ST ST STE 106
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-2009
Practice Address - Country:US
Practice Address - Phone:913-884-1055
Practice Address - Fax:913-884-1066
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant