Provider Demographics
NPI:1750944484
Name:CYRWAY, CHRISTINA ROSE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSE
Last Name:CYRWAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 E FLAMINGO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3144
Mailing Address - Country:US
Mailing Address - Phone:208-465-7121
Mailing Address - Fax:
Practice Address - Street 1:3904 E FLAMINGO AVE STE 100
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3144
Practice Address - Country:US
Practice Address - Phone:208-465-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID61208363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner