Basic Information
| Provider Information | |||||||||
| NPI: | 1841238243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSON | ||||||||
| FirstName: | CYNTHIA (CINDY) | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, RN, BC, FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SELBE | ||||||||
| OtherFirstName: | CINDY | ||||||||
| OtherMiddleName: | DEAN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 403 WOODLAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT SCOTT | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667018798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202238040 | ||||||||
| FaxNumber: | 6202238002 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660754078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133528379 | ||||||||
| FaxNumber: | 9133528998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 45518 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.