Provider Demographics
NPI:1932240520
Name:BROMLEY-KATOR, CYNTHIA RENEE (PAC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENEE
Last Name:BROMLEY-KATOR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:RENEE
Other - Last Name:BROMLEY-KATOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:2960 N CIRCLE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-776-4646
Mailing Address - Fax:719-776-4640
Practice Address - Street 1:2960 N CIRCLE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-776-4646
Practice Address - Fax:719-776-4640
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17450363A00000X
CO723363A00000X
VA011002658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP54995Medicare UPIN
S52347Medicare UPIN