Basic Information
| Provider Information | |||||||||
| NPI: | 1790741619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEVARA | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | RN,APN-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR STE 2300 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566960300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4701 OGLETOWN STANTON RD STE 1500 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234343 | ||||||||
| FaxNumber: | 3026234203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | L1-0038769 | DE | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN310556L | PA | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 26NJ00005100 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | VP003896G | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | LH-0000192 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 8901309 | 05 | NJ | MEDICAID |