Provider Demographics
NPI:1134596455
Name:ANDERSON, CYNTHIA LOUISE (ARNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 NE HOPKINS CT
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5622
Mailing Address - Country:US
Mailing Address - Phone:093-383-8005
Mailing Address - Fax:
Practice Address - Street 1:2560 NE HOPKINS COURT
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-5022
Practice Address - Country:US
Practice Address - Phone:509-338-3800
Practice Address - Fax:509-339-2702
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60582485363L00000X
IDNP-1590A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2054661Medicaid