Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | SP006343M | PA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0351192 | WV |
NPI | 1548206899 |
---|---|
Provider Name | Cynthia G Stockdale |
First Address | Washington, PA 15301 |
Second Address | Washington, PA 15301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 18/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P12548 | (02) | PA |