MEDICARE: MS. CYNTHIA ANN GILMORE CNM

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	367A00000X	Advanced Practice Midwife	1390	CA

General Provider Information

NPI Number	:	1689875916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA ANN GILMORE CNM

Provider Business Mailing Address
First Line	:	PO BOX 118
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93421-0118
Country	:	US
Telephone Number	:	805-904-3371
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 JAMES WAY
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-4973
Country	:	US
Telephone Number	:	805-543-1863
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	05/24/2011

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