Healthcare Provider Details

I. General information

NPI: 1144461914
Provider Name (Legal Business Name): CINDY LOU EGELSTON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 STONE CREEK DR
CHANHASSEN MN
55317-7410
US

IV. Provider business mailing address

2018 STONE CREEK DR
CHANHASSEN MN
55317-7410
US

V. Phone/Fax

Practice location:
  • Phone: 952-470-6005
  • Fax:
Mailing address:
  • Phone: 952-470-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR106374-5
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR106374-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: