Healthcare Provider Details

I. General information

NPI: 1831475052
Provider Name (Legal Business Name): CYNTHIA STOCKING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8272 MAIN STREET EXT
HAMMONDSPORT NY
14840-9701
US

IV. Provider business mailing address

8272 MAIN STREET EXT
HAMMONDSPORT NY
14840-9701
US

V. Phone/Fax

Practice location:
  • Phone: 607-569-5200
  • Fax: 607-569-5212
Mailing address:
  • Phone: 607-569-5200
  • Fax: 607-569-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number458945-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: