Individual provider Active NPI

Cynthia Ann Wildemuth, RNC MSN ARNP

  • Obstetrics & Gynecology Nurse Practitioner
  • Clinton, IA
National Provider Identifier
1891067765
Registry record updated Nov 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
F099435 Issued in IA
Practice address
2635 Lincoln Way Ste a
Clinton, IA 52732-7229
Phone
(563) 243-1413
Fax
(309) 558-2815
NPI assigned
Feb 7, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 209.004796 IL
Obstetrics & Gynecology Nurse Practitioner 363LX0001X F099435 IA Primary

Addresses

Primary practice location

2635 Lincoln Way Ste a
Clinton, IA 52732-7229

Mailing address

2635 Lincoln Way Ste a
Clinton, IA 52732-7229
Phone (563) 243-1413

Other practice location 1

2112 25th Avenue
Rock Island, IL 61201
Phone (309) 795-7088

Other practice location 2

229 S Main St
Maquoketa, IA 52060-3056
Phone (563) 652-3749

Other identifiers 1

IdentifierTypeStateIssuer
1891067765MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161129001435 IA Practitioner - Nurse Practitioner 3870873391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Womens Health Services of Eastern Iowa IncGroup PAC ID 0244120681, 4 clinicians

Practice addresses (Care Compare)

229 S Main St
Maquoketa, IA 52060-3056
Phone (563) 652-3749

2635 Lincoln Way a
Clinton, IA 52732-7203

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F099435IAMDObstetrics & Gynecology Nurse Practitioner
209.004796ILMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Womens Health Services of Eastern Iowa Inc CurrentSince Dec 1, 2016 Accepting new patients

Locations

2635 Lincoln Way
Clinton, IA 52732
Phone (563) 243-1413

2635 Lincoln Way
Ste A
Clinton, IA 52732
Phone (563) 241-1328

229 S Main St
Maquoketa, IA 52060
Phone (563) 352-3749

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1891067765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 LINCOLN WAY STE A",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527327229",
            "telephone_number": "563-243-1413",
            "fax_number": "309-558-2815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 LINCOLN WAY STE A",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527327229",
            "telephone_number": "563-243-1413",
            "fax_number": "309-558-2815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2112 25th Avenue",
            "address_purpose": "LOCATION",
            "city": "Rock Island",
            "state": "IL",
            "postal_code": "61201",
            "country_code": "US",
            "telephone_number": "309-795-7088",
            "fax_number": "309-558-2815",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "229 S Main St",
            "address_purpose": "LOCATION",
            "city": "Maquoketa",
            "state": "IA",
            "postal_code": "520603056",
            "country_code": "US",
            "telephone_number": "563-652-3749",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDEMUTH",
        "first_name": "CYNTHIA",
        "middle_name": "ANN",
        "credential": "RNC MSN ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-07",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "IL",
            "license": "209.004796",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "IA",
            "license": "F099435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891067765",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, IA

Sources for this page

Verify at the official NPI Registry.