Provider Demographics
NPI:1356776306
Name:BRICKNELL, CYNTHIA JOHANNA (FNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JOHANNA
Last Name:BRICKNELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2766
Mailing Address - Country:US
Mailing Address - Phone:574-732-2552
Mailing Address - Fax:574-732-0046
Practice Address - Street 1:166 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1569
Practice Address - Country:US
Practice Address - Phone:765-497-2428
Practice Address - Fax:765-497-4251
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004585A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily