Healthcare Provider Details

I. General information

NPI: 1164498143
Provider Name (Legal Business Name): CYNTHIA M PARENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 E REZANOF DR
KODIAK AK
99615-6602
US

IV. Provider business mailing address

PO BOX 3794
SOLDOTNA AK
99669-3794
US

V. Phone/Fax

Practice location:
  • Phone: 907-223-7513
  • Fax:
Mailing address:
  • Phone: 907-262-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN356760L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number199
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number524
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55330
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number30006426
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3367
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number948
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: