Healthcare Provider Details

I. General information

NPI: 1770703589
Provider Name (Legal Business Name): CYNTHIA K ROQUES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14532 S OUTER 40 RD DEPT ANESTHESIOLOGY
CHESTERFIELD MO
63017-5705
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 800-862-9980
  • Fax: 314-362-1185
Mailing address:
  • Phone: 800-862-9980
  • Fax: 314-362-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2002016203
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: