Provider Demographics
NPI:1992733703
Name:TENCH, CYNTHIA C (RN BC FNP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:C
Last Name:TENCH
Suffix:
Gender:F
Credentials:RN BC FNP
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:CATHERINE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3023 N BALLAS ROAD
Mailing Address - Street 2:PROFESSIONAL OFFICE BUILDING D SUITE 500
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-567-4541
Mailing Address - Fax:314-569-3647
Practice Address - Street 1:3023 N BALLAS ROAD
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING D SUITE 500
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-567-4541
Practice Address - Fax:314-569-3647
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO083709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS52901Medicare UPIN
000081398Medicare ID - Type Unspecified