Provider Demographics
NPI:1134148919
Name:ELLIOTT-ZIPPE, CYNTHIA GAIL (APN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAIL
Last Name:ELLIOTT-ZIPPE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:GAIL
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 78866
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-8866
Mailing Address - Country:US
Mailing Address - Phone:779-696-7150
Mailing Address - Fax:779-696-7342
Practice Address - Street 1:209 9TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104
Practice Address - Country:US
Practice Address - Phone:779-696-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003701363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03263Medicare PIN
ILP00156Medicare UPIN