Healthcare Provider Details

I. General information

NPI: 1700562865
Provider Name (Legal Business Name): CYNTHIA C WHITE APNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 W BLUEMOUND RD STE 200
BROOKFIELD WI
53005-5906
US

IV. Provider business mailing address

8427 W GLENDALE AVE
MILWAUKEE WI
53225-5119
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 414-406-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13818-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: