Provider Demographics
NPI:1194530469
Name:HISH, CINDY JO
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:JO
Last Name:HISH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 S 1175 W APT 93
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2903
Mailing Address - Country:US
Mailing Address - Phone:801-440-1380
Mailing Address - Fax:
Practice Address - Street 1:449 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2237
Practice Address - Country:US
Practice Address - Phone:801-440-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174155-3101405300000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No405300000XOther Service ProvidersPrevention Professional