Healthcare Provider Details

I. General information

NPI: 1316130792
Provider Name (Legal Business Name): CINDY S NOVELLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA SAMUELS

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 AIRPORT ROAD
BOONVILLE CA
95415
US

IV. Provider business mailing address

PO BOX 338
BOONVILLE CA
95415-0338
US

V. Phone/Fax

Practice location:
  • Phone: 707-895-3477
  • Fax:
Mailing address:
  • Phone: 707-895-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP17387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: