Provider Demographics
NPI:1700943628
Name:DIAL, CYNTHIA SUEANN
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUEANN
Last Name:DIAL
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:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-0511
Mailing Address - Country:US
Mailing Address - Phone:910-522-5340
Mailing Address - Fax:910-522-5341
Practice Address - Street 1:113 VANCE STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-0511
Practice Address - Country:US
Practice Address - Phone:910-522-5340
Practice Address - Fax:910-522-5341
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3568251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health