Provider Demographics
NPI:1982602165
Name:LODERMEIER, CYNTHIA TOMARA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:TOMARA
Last Name:LODERMEIER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FRANCE AVE SOUTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-806-0011
Mailing Address - Fax:952-806-9741
Practice Address - Street 1:6565 FRANCE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:952-806-0011
Practice Address - Fax:952-806-9741
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1223116363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP39402Medicare UPIN