Provider Demographics
NPI:1891067765
Name:WILDEMUTH, CYNTHIA ANN (RNC MSN ARNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:WILDEMUTH
Suffix:
Gender:F
Credentials:RNC MSN ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 LINCOLN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7229
Mailing Address - Country:US
Mailing Address - Phone:563-243-1413
Mailing Address - Fax:309-558-2815
Practice Address - Street 1:2635 LINCOLN WAY STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7229
Practice Address - Country:US
Practice Address - Phone:563-243-1413
Practice Address - Fax:309-558-2815
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.004796363LX0001X
IAF099435363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1891067765Medicaid