Healthcare Provider Details

I. General information

NPI: 1881888436
Provider Name (Legal Business Name): CYNTHIA LOUISE BELL NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 21414 BOX 3530
APO AE
09705
BE

IV. Provider business mailing address

SHAPE HEALTHCARE FACILITY UNIT 21414 BOX 3530
APO AE
09705
BE

V. Phone/Fax

Practice location:
  • Phone: 06544
  • Fax: 065445953
Mailing address:
  • Phone: 06544
  • Fax: 065445953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number492113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: