Provider Demographics
NPI:1023618600
Name:WILSON, CYNTHIA (MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 WETHERBOURNE CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2772
Mailing Address - Country:US
Mailing Address - Phone:240-484-3658
Mailing Address - Fax:
Practice Address - Street 1:1812 WETHERBOURNE CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2772
Practice Address - Country:US
Practice Address - Phone:240-484-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5076133NN1002X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management