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General NPI Number Information
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NPI Number | 1184447088
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Entity Type | Individual
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Provider Name | CYNTHIA LYNN HALTOM
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1721 DEAN DR
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-6235
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Country | US
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Telephone | 702-589-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 8545 S HIGHWAY 95 # 4145
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City | MOHAVE VALLEY
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State | AZ
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Zip | 86440-9309
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Country | US
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Telephone | 425-387-3080
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Fax |
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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