Provider Demographics
NPI:1457675811
Name:PROM, CYNTHIA ANN (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:PROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:WOLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:W180N8000 TOWN HALL RD
Mailing Address - Street 2:DIABETES AND NUTRITION EDUCATION SERVICES
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4002
Mailing Address - Country:US
Mailing Address - Phone:262-532-3239
Mailing Address - Fax:262-532-9512
Practice Address - Street 1:W180N8000 TOWN HALL RD
Practice Address - Street 2:DIABETES AND NUTRITION EDUCATION SERVICES
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4002
Practice Address - Country:US
Practice Address - Phone:262-532-3239
Practice Address - Fax:262-532-9512
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI98194-30163W00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse