Provider Demographics
NPI:1194855437
Name:BEHRENS, CYNTHIA RAE (FNP APN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RAE
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:FNP APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E PIKES PEAK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-632-3757
Mailing Address - Fax:719-632-2454
Practice Address - Street 1:1900 E PIKES PEAK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-632-2454
Practice Address - Fax:719-632-2454
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103967363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q59475Medicare UPIN
804258Medicare PIN