Healthcare Provider Details

I. General information

NPI: 1083574123
Provider Name (Legal Business Name): CINDY MCCORMACK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY GLOVER FNP

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 NW HOMESTEAD WAY
REDMOND OR
97756-9196
US

IV. Provider business mailing address

5255 NW HOMESTEAD WAY
REDMOND OR
97756-9196
US

V. Phone/Fax

Practice location:
  • Phone: 541-419-0116
  • Fax:
Mailing address:
  • Phone: 541-419-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number10053062
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: