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General NPI Number Information
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NPI Number | 1114074044
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Entity Type | Individual
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Provider Name | CYNTHIA A MANNINEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 810 E 3RD ST SUITE 201
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City | DURANGO
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State | CO
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Zip | 81301-5728
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Country | US
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Telephone | 970-764-1790
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Fax | 970-375-7927
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Provider Business Mailing Address
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Address Line | 810 E 3RD ST SUITE 201
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City | DURANGO
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State | CO
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Zip | 81301-5728
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Country | US
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Telephone | 970-764-1790
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Fax | 970-375-7927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101008368
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0051108
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License Number State | CO
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