Healthcare Provider Details

I. General information

NPI: 1275536625
Provider Name (Legal Business Name): CYNTHIA FESTGE RN -ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 N DOWNER AVE
MILWAUKEE WI
53211-2954
US

IV. Provider business mailing address

8512 W BLUEMOUND RD
WAUWATOSA WI
53226-4620
US

V. Phone/Fax

Practice location:
  • Phone: 414-229-4716
  • Fax:
Mailing address:
  • Phone: 414-259-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number50308-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: