Provider Demographics
NPI:1982896874
Name:ROBERTSON, CYNTHIA DANETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DANETTE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2850 W MILL RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3242
Mailing Address - Country:US
Mailing Address - Phone:414-352-6524
Mailing Address - Fax:414-352-6524
Practice Address - Street 1:5309 W FOND DU LAC AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1347
Practice Address - Country:US
Practice Address - Phone:414-352-6524
Practice Address - Fax:414-352-6524
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138489163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health