Provider Demographics
NPI:1487811972
Name:SJOLANDER, CYNTHIA LOUISE
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:SJOLANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4894 N KINNEY COULEE RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8613
Mailing Address - Country:US
Mailing Address - Phone:608-792-4911
Mailing Address - Fax:
Practice Address - Street 1:W4894 N KINNEY COULEE RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8613
Practice Address - Country:US
Practice Address - Phone:608-792-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38450900Medicaid