Basic Information
| Provider Information | |||||||||
| NPI: | 1639327307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIEFER | ||||||||
| FirstName: | CYNTHIE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1406 SE 164TH AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986839663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609400810 | ||||||||
| FaxNumber: | 3605973436 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 MOUNTAIN ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758821324 | ||||||||
| FaxNumber: | 7758829714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2008 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA1582 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.