Provider Demographics
NPI:1316471121
Name:TENNANT, CYNTHIA (RN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:TENNANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5797 DELANEY RD SE
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:OR
Mailing Address - Zip Code:97392-9440
Mailing Address - Country:US
Mailing Address - Phone:503-480-9349
Mailing Address - Fax:
Practice Address - Street 1:5797 DELANEY RD SE
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:OR
Practice Address - Zip Code:97392-9440
Practice Address - Country:US
Practice Address - Phone:503-480-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201043439RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse