MEDICARE: CYNTHIA FESTGE RN -ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	50308-030	WI

General Provider Information

NPI Number	:	1275536625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA FESTGE RN -ANP

Provider Business Mailing Address
First Line	:	8512 W BLUEMOUND RD
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4620
Country	:	US
Telephone Number	:	414-259-0241
Fax Number	:

Provider Business Practice Location Address
First Line	:	3351 N DOWNER AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-2954
Country	:	US
Telephone Number	:	414-229-4716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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