Provider Demographics
NPI:1316395049
Name:WILSON, CYNTHIA D
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47382 VICTORIAN SQ S
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6329
Mailing Address - Country:US
Mailing Address - Phone:313-310-5745
Mailing Address - Fax:
Practice Address - Street 1:47382 VICTORIAN SQ S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-6329
Practice Address - Country:US
Practice Address - Phone:313-310-5745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other