Provider Demographics
NPI:1346404431
Name:PETRIE, CINDY J (RN, WOC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:J
Last Name:PETRIE
Suffix:
Gender:F
Credentials:RN, WOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1042
Mailing Address - Country:US
Mailing Address - Phone:651-428-1820
Mailing Address - Fax:
Practice Address - Street 1:7060 SPRINGHILL CIR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-2615
Practice Address - Country:US
Practice Address - Phone:952-993-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-169133-7163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy