Provider Demographics
NPI:1235475039
Name:FREDERICK, CYNTHIA GAIL (CRNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAIL
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:GAIL
Other - Last Name:DONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:270 INTERSTATE COMMERCIAL PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7361
Mailing Address - Country:US
Mailing Address - Phone:334-356-4480
Mailing Address - Fax:
Practice Address - Street 1:270 INTERSTATE COMMERCIAL PARK LOOP
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7361
Practice Address - Country:US
Practice Address - Phone:334-356-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-080820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2009009580OtherAMERICAN NURSES CREDENTIALING CENTER