Healthcare Provider Details

I. General information

NPI: 1841238243
Provider Name (Legal Business Name): CYNTHIA (CINDY) DEAN LARSON MSN, RN, BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CINDY DEAN SELBE

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST
PLEASANTON KS
66075-4078
US

IV. Provider business mailing address

403 WOODLAND HILLS BLVD
FORT SCOTT KS
66701-8798
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-8379
  • Fax: 913-352-8998
Mailing address:
  • Phone: 620-223-8040
  • Fax: 620-223-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number45518
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: