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General NPI Number Information
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NPI Number | 1386643146
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Entity Type | Individual
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Provider Name | CYNTHIA RAY CULP FNP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 951 E PLAZA DR SUITE NUMBER 110
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City | EAGLE
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State | ID
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Zip | 83616-6566
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Country | US
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Telephone | 208-938-5680
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Fax | 208-938-5679
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Provider Business Mailing Address
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Address Line | 1199 N MACAILE WAY
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City | EAGLE
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State | ID
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Zip | 83616-6919
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Country | US
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Telephone | 208-938-5680
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Fax | 208-938-5679
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | N-20880 NP-365
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License Number State | ID
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