Provider Demographics
NPI:1114034089
Name:WILLIAMS, CYNTHIA M (NP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:MAE
Other - Last Name:RAMBO
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:920-755-2101
Mailing Address - Fax:920-755-2658
Practice Address - Street 1:175 S STATE ST
Practice Address - Street 2:
Practice Address - City:MISHICOT
Practice Address - State:WI
Practice Address - Zip Code:54228-9211
Practice Address - Country:US
Practice Address - Phone:920-755-2101
Practice Address - Fax:920-755-2658
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138943-030363L00000X
WI2701-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41273900Medicaid