Provider Demographics
NPI:1316130792
Name:NOVELLA, CINDY S (FNP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:S
Last Name:NOVELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95415-0338
Mailing Address - Country:US
Mailing Address - Phone:707-895-3477
Mailing Address - Fax:
Practice Address - Street 1:13500 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95415
Practice Address - Country:US
Practice Address - Phone:707-895-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP17387OtherFNP