Provider Demographics
NPI:1104974849
Name:CRUIKSHANK, CINDY S (NP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:S
Last Name:CRUIKSHANK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9943 HICKMAN RD
Mailing Address - Street 2:STE 105
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5304
Mailing Address - Country:US
Mailing Address - Phone:515-248-1400
Mailing Address - Fax:515-248-1440
Practice Address - Street 1:412 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2947
Practice Address - Country:US
Practice Address - Phone:641-753-4021
Practice Address - Fax:641-753-4025
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-066702363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR83235Medicare UPIN