Provider Demographics
NPI:1700562865
Name:WHITE, CYNTHIA C (APNP, PMHNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:APNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-5119
Mailing Address - Country:US
Mailing Address - Phone:414-406-1189
Mailing Address - Fax:
Practice Address - Street 1:950 N 35TH ST FL 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3318
Practice Address - Country:US
Practice Address - Phone:414-775-7739
Practice Address - Fax:229-202-5256
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13818-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health