Provider Demographics
NPI:1528263076
Name:COUNTRYMAN, CYNTHIA J (ARNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:COUNTRYMAN
Suffix:
Gender:F
Credentials:ARNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3161
Mailing Address - Country:US
Mailing Address - Phone:317-871-8811
Mailing Address - Fax:317-871-8833
Practice Address - Street 1:6940 MICHIGAN RD
Practice Address - Street 2:SUITE 140
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2800
Practice Address - Country:US
Practice Address - Phone:317-266-2901
Practice Address - Fax:317-266-2916
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2021-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP 60167721363L00000X
IN71001936A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200866670Medicaid
INQ06833Medicare UPIN
IN715530BMMMMedicare PIN