Basic Information
| Provider Information | |||||||||
| NPI: | 1801084439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ETHERIDGE | ||||||||
| FirstName: | CYNTHIA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8060 WOLF RIVER BLVD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012711000 | ||||||||
| FaxNumber: | 9012714135 | ||||||||
| Practice Location | |||||||||
| Address1: | 8060 WOLF RIVER BLVD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012711000 | ||||||||
| FaxNumber: | 9012714135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 12/29/2011 | ||||||||
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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 | 363LA2100X | 0000130017 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.