1720378029 NPI number — MS. CYNTHIA B. OBLETZ CYNTHIA OBLETZ

Table of content: MS. CYNTHIA B. OBLETZ CYNTHIA OBLETZ (NPI 1720378029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720378029 NPI number — MS. CYNTHIA B. OBLETZ CYNTHIA OBLETZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBLETZ
Provider First Name:
CYNTHIA
Provider Middle Name:
B.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CYNTHIA OBLETZ
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBLETZ
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
B.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720378029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1906 E SHOREWOOD BLVD
Provider Second Line Business Mailing Address:
UNITE 156
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53211-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-562-9443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 E SHOREWOOD BLVD
Provider Second Line Business Practice Location Address:
UNIT 156
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-562-9443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  128748-030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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