Healthcare Provider Details

I. General information

NPI: 1962467456
Provider Name (Legal Business Name): CYNTHIA S. LEWIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SERGEANT SQUARE DR
SERGEANT BLUFF IA
51054-7729
US

IV. Provider business mailing address

319 SERGEANT SQUARE DR
SERGEANT BLUFF IA
51054-7729
US

V. Phone/Fax

Practice location:
  • Phone: 712-943-2500
  • Fax: 712-943-5696
Mailing address:
  • Phone: 712-943-2500
  • Fax: 712-943-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number059326
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110627
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: