Healthcare Provider Details

I. General information

NPI: 1144381740
Provider Name (Legal Business Name): CYNTHIA POWELL FETHERSTON M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-7991
  • Fax: 916-973-7971
Mailing address:
  • Phone: 916-973-7991
  • Fax: 916-973-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: