Provider Demographics
NPI:1841269339
Name:VIEIRALVES-WILTGEN, CYNTHIA (GNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:VIEIRALVES-WILTGEN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:CYNCHA
Other - Middle Name:
Other - Last Name:VIERALVES-WILTGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GNP
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2111
Practice Address - Country:US
Practice Address - Phone:952-836-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0943675363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS77061Medicare UPIN