Healthcare Provider Details

I. General information

NPI: 1770889685
Provider Name (Legal Business Name): CYNTHIA L WURSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY L WURSTER

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SUNRISE AVE
ROSEVILLE CA
95661-3479
US

IV. Provider business mailing address

20022 LAKESIDE LN
PENN VALLEY CA
95946-9467
US

V. Phone/Fax

Practice location:
  • Phone: 916-783-5207
  • Fax:
Mailing address:
  • Phone: 530-432-8513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: