Healthcare Provider Details

I. General information

NPI: 1972003549
Provider Name (Legal Business Name): CYNTHIA MARIE WECKER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E CAPITOL DR STE 1700
APPLETON WI
54911-8735
US

IV. Provider business mailing address

2500 E CAPITOL DR STE 1700
APPLETON WI
54911-8735
US

V. Phone/Fax

Practice location:
  • Phone: 920-734-4773
  • Fax:
Mailing address:
  • Phone: 920-734-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number130765-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number8077-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: