Provider Demographics
NPI:1144613308
Name:DAH, CYNTHIA (DNP-FNP-C, RN)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:DAH
Suffix:
Gender:F
Credentials:DNP-FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1004
Mailing Address - Country:US
Mailing Address - Phone:269-815-0330
Mailing Address - Fax:
Practice Address - Street 1:HWY 98 NAVAJO ROUTE 16
Practice Address - Street 2:
Practice Address - City:SHONTO
Practice Address - State:AZ
Practice Address - Zip Code:86054
Practice Address - Country:US
Practice Address - Phone:928-672-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA782837163W00000X
MI4704261309163W00000X, 363LF0000X
NY613142163W00000X
IL041416245163W00000X
NM55771363LF0000X, 163W00000X
AK224123163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020529Medicaid