Provider Demographics
NPI:1649542275
Name:ELY, CYNTHIA (RN, CLNC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:ELY
Suffix:
Gender:F
Credentials:RN, CLNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-7704
Mailing Address - Country:US
Mailing Address - Phone:720-883-3954
Mailing Address - Fax:720-733-2788
Practice Address - Street 1:1822 OVERTON DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-7704
Practice Address - Country:US
Practice Address - Phone:720-883-3954
Practice Address - Fax:720-733-2788
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107259163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy