Healthcare Provider Details

I. General information

NPI: 1083766422
Provider Name (Legal Business Name): CYNTHIA FAYE HALE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11510 S FORTUNA RD STE A
YUMA AZ
85367-7886
US

IV. Provider business mailing address

11510 S FORTUNA RD STE A
YUMA AZ
85367-7886
US

V. Phone/Fax

Practice location:
  • Phone: 928-342-7046
  • Fax: 928-342-7018
Mailing address:
  • Phone: 928-342-7046
  • Fax: 928-342-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number110298
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP1045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: