Provider Demographics
NPI:1386743060
Name:VALENTIN, CYNTHIA CELESTE-TROUT (PHD APNP)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:CELESTE-TROUT
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:PHD APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2504
Mailing Address - Country:US
Mailing Address - Phone:414-773-4312
Mailing Address - Fax:414-454-6522
Practice Address - Street 1:1220 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2504
Practice Address - Country:US
Practice Address - Phone:414-773-4312
Practice Address - Fax:414-454-6522
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63565030163W00000X
WI1908033363LP0808X
WI1589057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39231700Medicaid
WI39231700Medicaid
S31080Medicare UPIN