Healthcare Provider Details

I. General information

NPI: 1184710956
Provider Name (Legal Business Name): CYNTHIA MATTSON MCCREADY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMDEN AVE HOLLOWAY HALL RM 180
SALISBURY MD
21801-6860
US

IV. Provider business mailing address

5439 E NITHSDALE DR
SALISBURY MD
21801-2462
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-6262
  • Fax: 410-548-4101
Mailing address:
  • Phone: 410-543-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR077019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: