Provider Demographics
NPI:1205936689
Name:IVAN, CYNTHIA SHAW (NP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SHAW
Last Name:IVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1545 GOODYEAR DR STE D
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6063
Mailing Address - Country:US
Mailing Address - Phone:915-280-4684
Mailing Address - Fax:915-594-3043
Practice Address - Street 1:1545 GOODYEAR DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6063
Practice Address - Country:US
Practice Address - Phone:915-280-4684
Practice Address - Fax:915-534-3043
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX630269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner