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General NPI Number Information
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NPI Number | 1508193574
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Entity Type | Individual
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Provider Name | CYNDIA MARIE MOCK CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 8220 SAN PEDRO DR NE STE 220
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2480
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Country | US
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Telephone | 505-797-4466
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Fax | 505-797-2275
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Provider Business Mailing Address
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Address Line | PO BOX 1506
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City | CHEHALIS
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State | WA
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Zip | 98532-0409
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Country | US
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Telephone | 360-242-3008
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Fax | 360-807-7687
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 01220
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704251927
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License Number State | MI
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