Provider Demographics
NPI:1336958396
Name:STORMO, CYNTHIA JOYCE (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JOYCE
Last Name:STORMO
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 1:2755 SILVER CREEK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8347
Mailing Address - Country:US
Mailing Address - Phone:702-518-0137
Mailing Address - Fax:
Practice Address - Street 1:2755 SILVER CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8347
Practice Address - Country:US
Practice Address - Phone:702-518-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse