Healthcare Provider Details

I. General information

NPI: 1902806037
Provider Name (Legal Business Name): CYNTHIA MARIE FELLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA FELLER ELLISON CRNA

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL LEMOORE 937 FRANKLIN AVE
LEMOORE CA
93246-0001
US

IV. Provider business mailing address

3172 SPEICHER CIR
LEMOORE CA
93245-2233
US

V. Phone/Fax

Practice location:
  • Phone: 559-998-4201
  • Fax: 559-998-4682
Mailing address:
  • Phone: 559-998-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number308066-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: