Provider Demographics
NPI:1932125168
Name:MOON, CYNTHIA J (AHCNS)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:J
Last Name:MOON
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Gender:F
Credentials:AHCNS
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8109-37-920
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-7224
Mailing Address - Fax:877-991-4780
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG ONCOLOGY, STE 5F
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-2280
Practice Address - Fax:888-352-8360
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-11-17
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Provider Licenses
StateLicense IDTaxonomies
MO90956364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427190301Medicaid
ILENROLLEDMedicaid