Provider Demographics
NPI:1922197946
Name:DALSING, CYNTHIA W (NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:W
Last Name:DALSING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 MICHIGAN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5014
Mailing Address - Country:US
Mailing Address - Phone:208-263-1299
Mailing Address - Fax:208-263-1557
Practice Address - Street 1:1215 MICHIGAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5014
Practice Address - Country:US
Practice Address - Phone:208-263-1299
Practice Address - Fax:208-263-1557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP255A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13417641OtherMEDICARE INDIVIDUAL PTAN
ID1370066OtherMEDICARE GROUP PTAN
ID804142500Medicaid
ID1370066OtherMEDICARE GROUP PTAN