Provider Demographics
NPI:1952457269
Name:KLABUNDE, CYNTHIA RAE (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RAE
Last Name:KLABUNDE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:GENOA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53128-2062
Mailing Address - Country:US
Mailing Address - Phone:262-279-6909
Mailing Address - Fax:
Practice Address - Street 1:949 BONNIE LN
Practice Address - Street 2:
Practice Address - City:GENOA CITY
Practice Address - State:WI
Practice Address - Zip Code:53128-2062
Practice Address - Country:US
Practice Address - Phone:262-279-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35015200Medicaid