Provider Demographics
NPI:1740627710
Name:RASTEDT, CYNTHIA KAY (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:KAY
Last Name:RASTEDT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 WEST RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502
Mailing Address - Country:US
Mailing Address - Phone:218-847-1385
Mailing Address - Fax:218-847-1388
Practice Address - Street 1:119 GRAYSTONE PLAZA
Practice Address - Street 2:SUITE 110
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56502
Practice Address - Country:US
Practice Address - Phone:218-844-5832
Practice Address - Fax:218-844-5834
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-140546-8163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health