Provider Demographics
NPI:1467683920
Name:WILSON, CYNTHIA ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TAHOMA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7735
Mailing Address - Country:US
Mailing Address - Phone:360-458-7761
Mailing Address - Fax:
Practice Address - Street 1:201 TAHOMA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7735
Practice Address - Country:US
Practice Address - Phone:360-458-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60558786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine