Healthcare Provider Details

I. General information

NPI: 1205116795
Provider Name (Legal Business Name): CYNTHIA (CINDY) R DAVIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2011
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 N WOODS TRL
HAMPSTEAD MD
21074-3128
US

IV. Provider business mailing address

4231 N WOODS TRL
HAMPSTEAD MD
21074-3128
US

V. Phone/Fax

Practice location:
  • Phone: 410-374-9391
  • Fax: 410-871-7967
Mailing address:
  • Phone: 410-374-9391
  • Fax: 410-871-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR068683
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR068683
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR068683
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR068683
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: