Provider Demographics
NPI:1811958192
Name:SURRETT, CINDY M (NP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:M
Last Name:SURRETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:M
Other - Last Name:THROWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-7777
Mailing Address - Fax:336-718-7744
Practice Address - Street 1:1351 WESTGATE CENTER DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2934
Practice Address - Country:US
Practice Address - Phone:336-718-7777
Practice Address - Fax:336-718-7744
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300223363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005263Medicaid
NC7005263Medicaid