Provider Demographics
NPI:1881146918
Name:BOUTSOMSI, SIENH CINDY (RN)
Entity type:Individual
Prefix:
First Name:SIENH
Middle Name:CINDY
Last Name:BOUTSOMSI
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 1:1641 CARA LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3851
Mailing Address - Country:US
Mailing Address - Phone:907-222-5342
Mailing Address - Fax:
Practice Address - Street 1:1641 CARA LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3851
Practice Address - Country:US
Practice Address - Phone:907-222-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR25627376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator