Healthcare Provider Details

I. General information

NPI: 1215606587
Provider Name (Legal Business Name): CYNTHIA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 UTICA RIDGE RD
BETTENDORF IA
52722-1626
US

IV. Provider business mailing address

4500 UTICA RIDGE RD
BETTENDORF IA
52722-1626
US

V. Phone/Fax

Practice location:
  • Phone: 563-742-5000
  • Fax:
Mailing address:
  • Phone: 563-742-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number118544
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: