Provider Demographics
NPI:1629550868
Name:CYNTHIA R. BEHRENS
Entity Type:Organization
Organization Name:CYNTHIA R. BEHRENS
Other - Org Name:PIKES PEAK PRIMARY CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADVANCE PRACTICE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:719-632-3757
Mailing Address - Street 1:1900 E PIKES PEAK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5862
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 STE 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5862
Practice Address - Country:US
Practice Address - Phone:719-632-3757
Practice Address - Fax:719-632-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103967261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care