Healthcare Provider Details

I. General information

NPI: 1316074743
Provider Name (Legal Business Name): CYNTHIA JOAN HERRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 108TH AVE NE
BLAINE MN
55449-7439
US

IV. Provider business mailing address

4181 108TH AVE NE
BLAINE MN
55449-7439
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-0555
  • Fax:
Mailing address:
  • Phone: 763-581-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number81638
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: