Provider Demographics
NPI:1508009879
Name:MCGRAW, CYNTHIA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-2624
Mailing Address - Country:US
Mailing Address - Phone:920-973-2695
Mailing Address - Fax:
Practice Address - Street 1:2110 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-2624
Practice Address - Country:US
Practice Address - Phone:920-973-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303416031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse