Healthcare Provider Details

I. General information

NPI: 1356673941
Provider Name (Legal Business Name): CYNDE DUPRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNDE ANN STOUT

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 BLUE SPRUCE DR
FORT COLLINS CO
80524-2004
US

IV. Provider business mailing address

1525 BLUE SPRUCE DR
FORT COLLINS CO
80524-2004
US

V. Phone/Fax

Practice location:
  • Phone: 970-498-6711
  • Fax: 970-498-6772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number184648
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: