Provider Demographics
NPI:1215985973
Name:WILSON, CYNTHIA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:RENEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:HARDGRAVE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2710 RIFE MEDICAL LN
Mailing Address - Street 2:HOSPITALIST
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-8000
Mailing Address - Fax:479-338-2906
Practice Address - Street 1:2710 RIFE MEDICAL LN
Practice Address - Street 2:HOSPITALIST
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-8000
Practice Address - Fax:479-338-2906
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0507208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist