Provider Demographics
NPI:1881168573
Name:DAVIS, CYNTHIA ELAINE (AA, BA)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S FENWAY ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4091
Mailing Address - Country:US
Mailing Address - Phone:307-247-5950
Mailing Address - Fax:
Practice Address - Street 1:2940 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2619
Practice Address - Country:US
Practice Address - Phone:307-247-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program