Healthcare Provider Details

I. General information

NPI: 1144613308
Provider Name (Legal Business Name): CYNTHIA DAH DNP-FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 09/10/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 98 NAVAJO ROUTE 16
SHONTO AZ
86054
US

IV. Provider business mailing address

317 N HARRISON ST
BERRIEN SPRINGS MI
49103-1004
US

V. Phone/Fax

Practice location:
  • Phone: 928-672-3000
  • Fax:
Mailing address:
  • Phone: 269-815-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704261309
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55771
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782837
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704261309
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number613142
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041416245
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number55771
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number224123
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: