Provider Demographics
NPI:1215069075
Name:BOSTICK, CYNTHIA (APRN, BC, PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:APRN, BC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 SAN FERNANDO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4163
Mailing Address - Country:US
Mailing Address - Phone:949-375-2858
Mailing Address - Fax:505-522-0031
Practice Address - Street 1:2511 CHAPARRAL ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5701
Practice Address - Country:US
Practice Address - Phone:505-522-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR34639163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult