Healthcare Provider Details

I. General information

NPI: 1033515879
Provider Name (Legal Business Name): CYNTHIA L. WYLIE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA L. JENKINS

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N MAIN ST
SUFFOLK VA
23434-4422
US

IV. Provider business mailing address

341 N MAIN ST
SUFFOLK VA
23434-4422
US

V. Phone/Fax

Practice location:
  • Phone: 757-774-6790
  • Fax: 888-764-2501
Mailing address:
  • Phone: 757-774-6790
  • Fax: 888-764-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024172161
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: