Healthcare Provider Details

I. General information

NPI: 1205827631
Provider Name (Legal Business Name): CINDY B HANKES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 STATE ST
FOX LAKE WI
53933-9550
US

IV. Provider business mailing address

420 E DIVISION ST
FOND DU LAC WI
54935-4560
US

V. Phone/Fax

Practice location:
  • Phone: 920-928-6300
  • Fax:
Mailing address:
  • Phone: 920-926-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1153
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: