Provider Demographics
NPI:1437487857
Name:ANDERSON, CYNTHIA DENNELLE (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DENNELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19309 UPLAND ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4140
Mailing Address - Country:US
Mailing Address - Phone:763-706-7300
Mailing Address - Fax:763-241-0196
Practice Address - Street 1:19309 UPLAND ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4140
Practice Address - Country:US
Practice Address - Phone:763-706-7300
Practice Address - Fax:763-241-0196
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343760163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health