Provider Demographics
NPI:1912498593
Name:WALD, CYNTHIA LYNN (DNP-C, FNP-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:WALD
Suffix:
Gender:F
Credentials:DNP-C, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 WINNIPEG DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0378
Mailing Address - Country:US
Mailing Address - Phone:701-226-4432
Mailing Address - Fax:
Practice Address - Street 1:2792 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5177
Practice Address - Country:US
Practice Address - Phone:701-221-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26382363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine