Provider Demographics
NPI:1033515879
Name:WYLIE, CYNTHIA L (CNM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:WYLIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3217 WESTERN BRANCH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5235
Mailing Address - Country:US
Mailing Address - Phone:757-774-6790
Mailing Address - Fax:888-764-2501
Practice Address - Street 1:3217 WESTERN BRANCH BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5235
Practice Address - Country:US
Practice Address - Phone:757-774-6790
Practice Address - Fax:888-764-2501
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172161367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife