Provider Demographics
NPI:1740684752
Name:WOJTKOWIAK, CYNTHIA ROSE (RN IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ROSE
Last Name:WOJTKOWIAK
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MOHICAN RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2761
Mailing Address - Country:US
Mailing Address - Phone:860-202-8322
Mailing Address - Fax:
Practice Address - Street 1:52 MOHICAN RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2761
Practice Address - Country:US
Practice Address - Phone:860-202-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE40061163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant