Provider Demographics
NPI:1972984565
Name:KATANCIK, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KATANCIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:TOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:22400 SALAMO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8269
Mailing Address - Country:US
Mailing Address - Phone:503-657-6010
Mailing Address - Fax:503-655-0753
Practice Address - Street 1:22400 SALAMO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-8269
Practice Address - Country:US
Practice Address - Phone:503-657-6010
Practice Address - Fax:503-655-0753
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA165502363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical