Healthcare Provider Details

I. General information

NPI: 1740339258
Provider Name (Legal Business Name): CYNTHIA L THYGESEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HEWITT DR SUITE 203B
WACO TX
76712-8833
US

IV. Provider business mailing address

1201 HEWITT DRIVE SUITE 203B
WACO TX
76712
US

V. Phone/Fax

Practice location:
  • Phone: 254-666-3627
  • Fax: 254-732-6125
Mailing address:
  • Phone: 254-666-3627
  • Fax: 254-732-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number582987
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP114752
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: