Provider Demographics
NPI:1720268485
Name:AVERA, CYNTHIA DIANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANNE
Last Name:AVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNCH RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4019
Mailing Address - Country:US
Mailing Address - Phone:706-561-6422
Mailing Address - Fax:706-494-4387
Practice Address - Street 1:7400 LYNCH RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4019
Practice Address - Country:US
Practice Address - Phone:706-561-6422
Practice Address - Fax:706-494-4387
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN167850163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse