Provider Demographics
NPI:1396036901
Name:CAYER-WIRTZ, CONSTANCE LYNN (NP)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:LYNN
Last Name:CAYER-WIRTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:200 OCENAGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6199
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:11200 W PARKLAND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3127
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-499-6171
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4361-033363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health