Provider Demographics
NPI:1770729485
Name:AIKEN, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:AIKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2291
Mailing Address - Country:US
Mailing Address - Phone:484-351-3206
Mailing Address - Fax:
Practice Address - Street 1:2320 LINEVILLE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-8836
Practice Address - Country:US
Practice Address - Phone:920-445-7222
Practice Address - Fax:920-445-7238
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3544-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI078450052Medicare Oscar/Certification