Provider Demographics
NPI:1801007844
Name:ANDERSON, CINDY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2605
Mailing Address - Country:US
Mailing Address - Phone:701-746-7104
Mailing Address - Fax:701-777-4096
Practice Address - Street 1:1551 28TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6782
Practice Address - Country:US
Practice Address - Phone:701-775-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR23958363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19034OtherND BLUE CROSS BLUE SHIELD
ND53595Medicaid