Provider Demographics
NPI:1699047936
Name:HORTON, CYNTHIA A (LPN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:HORTON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411B BRAMBLEBUSH CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1301
Mailing Address - Country:US
Mailing Address - Phone:315-622-1268
Mailing Address - Fax:
Practice Address - Street 1:8411B BRAMBLEBUSH CIR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1301
Practice Address - Country:US
Practice Address - Phone:315-622-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089094164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse