Basic Information
| Provider Information | |||||||||
| NPI: | 1801901996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITLOCK | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | APN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 MILL ST # MCM14 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825262 | ||||||||
| FaxNumber: | 7759825496 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 RYLAND ST | ||||||||
| Address2: | STE 105 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825640 | ||||||||
| FaxNumber: | 7759825641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | APRN000899 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363L00000X | APRN000899 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1801901996 | 05 | NV | MEDICAID | 47009233 | 05 | NM | MEDICAID | 11934137 | 01 | CAQH | OTHER |