Provider Demographics
NPI:1598938466
Name:NOTZ, CYNTHIA MARIE
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:NOTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:WIESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:N2342 NORMAN LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8700
Mailing Address - Country:US
Mailing Address - Phone:920-735-1214
Mailing Address - Fax:
Practice Address - Street 1:N2342 NORMAN LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8700
Practice Address - Country:US
Practice Address - Phone:920-735-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34355-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38248000OtherMEDICAID PROVIDER