MEDICARE: CYNTHIA KATHLEEN SCHWAB CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	534673	TX

General Provider Information

NPI Number	:	1134102031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA KATHLEEN SCHWAB CPNP

Provider Business Mailing Address
First Line	:	3124 BELLAIRE DR W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2141
Country	:	US
Telephone Number	:	817-715-8359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2528 JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2206
Country	:	US
Telephone Number	:	817-624-1770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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