Provider Demographics
NPI:1104248392
Name:NIELSEN, CYNTHIA LOUISE (MSN ANP-BC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MSN ANP-BC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8208 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1757
Mailing Address - Country:US
Mailing Address - Phone:505-858-1222
Mailing Address - Fax:505-858-1224
Practice Address - Street 1:8208 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1757
Practice Address - Country:US
Practice Address - Phone:505-858-1222
Practice Address - Fax:505-858-1224
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-02321363L00000X
NMR19639363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48838543Medicaid
NM48838543Medicaid