Provider Demographics
NPI:1124143409
Name:NASH, CYNTHIA I (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:I
Last Name:NASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:BRAZELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3404 COUNTRY CLUB PL
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3034
Mailing Address - Country:US
Mailing Address - Phone:316-686-0884
Mailing Address - Fax:
Practice Address - Street 1:538 S BLECKLEY DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2402
Practice Address - Country:US
Practice Address - Phone:800-879-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine