Healthcare Provider Details

I. General information

NPI: 1467544460
Provider Name (Legal Business Name): CYNTHIA MARIE MOSBRUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY MARIE MOSBRUCKER

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/02/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11505 BURNHAM DRIVE SUITE 302
GIG HARBOR WA
98332
US

IV. Provider business mailing address

11505 BURNHAM DRIVE SUITE 302
GIG HARBOR WA
98332
US

V. Phone/Fax

Practice location:
  • Phone: 253-313-5997
  • Fax: 253-313-5197
Mailing address:
  • Phone: 253-313-5997
  • Fax: 253-313-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number60016675
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number60016675
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: