Active NPI
Cynthia Ann Stavish, MSN, AHCNS, APRN
- Critical Care Medicine Clinical Nurse Specialist
- Saint Paul, MN
National Provider Identifier
1114674652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine Clinical Nurse Specialist
- License
- 522
- Practice address
- 5673 Jenni LN
Saint Paul, MN 55110-5721 - Phone
- (651) 208-9291
- Fax
- (651) 340-5143
- NPI assigned
- Mar 4, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Clinical Nurse Specialist | 364SA2100X | 522 | MN | |
| Critical Care Medicine Clinical Nurse Specialist | 364SC0200X | 522 | MN | Primary |
Addresses
Primary practice location
5673 Jenni LN
Saint Paul, MN 55110-5721
Mailing address
5673 Jenni LN
Saint Paul, MN 55110-5721
Phone (651) 208-9291
Other names 1
- Mrs. Cynthia Ann Lyczkowski
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cstavish@daxor.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 522 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646352000000",
"number": "1114674652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5673 JENNI LN",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551105721",
"telephone_number": "651-208-9291",
"fax_number": "651-340-5143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5673 JENNI LN",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551105721",
"telephone_number": "651-208-9291",
"fax_number": "651-340-5143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAVISH",
"first_name": "CYNTHIA",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "MSN, AHCNS, APRN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-04",
"last_updated": "2022-03-04",
"certification_date": "2022-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "364SA2100X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Acute Care",
"state": "MN",
"license": "522",
"primary": false
},
{
"code": "364SC0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Clinical Nurse Specialist, Critical Care Medicine",
"state": "MN",
"license": "522",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cstavish@daxor.com",
"affiliation": "N",
"endpointDescription": "Home Office",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "5673 Jenni Ln",
"city": "Saint Paul",
"state": "MN",
"country_code": "US",
"postal_code": "551105721",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "CYNTHIA",
"last_name": "LYCZKOWSKI",
"middle_name": "ANN",
"prefix": "MRS.",
"credential": "MSN, RN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.