Provider Demographics
NPI:1902861859
Name:KLEIN, CYNTHIA L (CNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:KLEIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4577 E JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1822
Mailing Address - Country:US
Mailing Address - Phone:614-855-7208
Mailing Address - Fax:614-340-3295
Practice Address - Street 1:745 W STATE ST
Practice Address - Street 2:STE 750
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1515
Practice Address - Country:US
Practice Address - Phone:614-224-2281
Practice Address - Fax:614-221-8869
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA059043-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
29464431001OtherMEDICAL MUTUAL OF OHIO
00000000358356OtherANTHEM
OH2561697Medicaid
00000000358356OtherANTHEM
KLNP17561Medicare ID - Type Unspecified
KLNP17562Medicare ID - Type Unspecified