Provider Demographics
NPI:1780787630
Name:STADLER, CYNTHIA MARQUESS (CNM)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARQUESS
Last Name:STADLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:JANE
Other - Last Name:MARQUESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 1590
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-1590
Mailing Address - Country:US
Mailing Address - Phone:802-526-2380
Mailing Address - Fax:802-526-2518
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-4428
Practice Address - Country:US
Practice Address - Phone:802-526-2380
Practice Address - Fax:802-256-2518
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH045223-23-01367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1927Medicaid
VTOVN1927Medicaid