Provider Demographics
NPI:1205057395
Name:BURTON, CYNTHIA KAY (LPN PCA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:BURTON
Suffix:
Gender:F
Credentials:LPN PCA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:KAY
Other - Last Name:BRAATEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:FRAZEE
Mailing Address - State:MN
Mailing Address - Zip Code:56544
Mailing Address - Country:US
Mailing Address - Phone:218-334-3630
Mailing Address - Fax:218-998-3187
Practice Address - Street 1:106 NORTH 4TH AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0508418164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse