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General NPI Number Information
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NPI Number | 1750944484
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Entity Type | Individual
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Provider Name | CHRISTINA ROSE CYRWAY NP
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Gender | Female
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 3904 E FLAMINGO AVE STE 100
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City | NAMPA
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State | ID
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Zip | 83687-3144
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Country | US
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Telephone | 208-465-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 3904 E FLAMINGO AVE STE 100
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City | NAMPA
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State | ID
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Zip | 83687-3144
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Country | US
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Telephone | 208-465-7121
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 61208
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 61208
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License Number State | ID
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