Provider Demographics
NPI:1184447088
Name:HALTOM, CYNTHIA LYNN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:HALTOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 S HIGHWAY 95 # 4145
Mailing Address - Street 2:
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86440-9309
Mailing Address - Country:US
Mailing Address - Phone:425-387-3080
Mailing Address - Fax:
Practice Address - Street 1:1721 DEAN DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6235
Practice Address - Country:US
Practice Address - Phone:702-589-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider