Healthcare Provider Details

I. General information

NPI: 1811033616
Provider Name (Legal Business Name): CYNTHIA ANN WEIR CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 LAKE DR
SANTA ROSA NM
88435-2559
US

IV. Provider business mailing address

724 LAKE DR
SANTA ROSA NM
88435-2559
US

V. Phone/Fax

Practice location:
  • Phone: 505-472-4311
  • Fax:
Mailing address:
  • Phone: 505-472-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR59797
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: