Provider Demographics
NPI:1518786847
Name:GREEN, CYNTHIA LEIGH (RNC, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEIGH
Last Name:GREEN
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 ALEXANDER ST APT 204
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1231
Mailing Address - Country:US
Mailing Address - Phone:706-325-9418
Mailing Address - Fax:
Practice Address - Street 1:642 ULUKAHIKI ST STE 305
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4439
Practice Address - Country:US
Practice Address - Phone:808-263-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA188233163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant