MEDICARE: MRS. CYNTHIA ANN WEIR CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R59797	NM

General Provider Information

NPI Number	:	1811033616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA ANN WEIR CFNP

Provider Business Mailing Address
First Line	:	724 LAKE DR
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2559
Country	:	US
Telephone Number	:	505-472-4311
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 LAKE DR
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2559
Country	:	US
Telephone Number	:	505-472-4311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	10/29/2009

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