1932278439 NPI number — DR. CYNTHIA MARIE WALLJASPER MCWILLIAMS PHD

Table of content: DR. CYNTHIA MARIE WALLJASPER MCWILLIAMS PHD (NPI 1932278439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932278439 NPI number — DR. CYNTHIA MARIE WALLJASPER MCWILLIAMS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLJASPER MCWILLIAMS
Provider First Name:
CYNTHIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALLJASPER
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932278439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 W WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52641-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-385-1919
Provider Business Mailing Address Fax Number:
319-385-9026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52641-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-385-1919
Provider Business Practice Location Address Fax Number:
319-385-9026
Provider Enumeration Date:
11/07/2006

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: 103TC0700X , with the licence number:  00919 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0739961 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".