Healthcare Provider Details

I. General information

NPI: 1346673548
Provider Name (Legal Business Name): CYNTHIA CUE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SAINT PATRICKS DR SUITE 502
WALDORF MD
20603-4527
US

IV. Provider business mailing address

10 SAINT PATRICKS DR SUITE 502
WALDORF MD
20603-4527
US

V. Phone/Fax

Practice location:
  • Phone: 301-885-3350
  • Fax: 301-885-0089
Mailing address:
  • Phone: 301-885-3350
  • Fax: 301-885-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR163593
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: