Provider Demographics
NPI:1003180639
Name:NORDBY, CYNTHIA JANE (LAC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JANE
Last Name:NORDBY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14166 QUINCE ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4137
Mailing Address - Country:US
Mailing Address - Phone:763-246-3358
Mailing Address - Fax:
Practice Address - Street 1:14166 QUINCE ST NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4137
Practice Address - Country:US
Practice Address - Phone:763-246-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1354171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist