Healthcare Provider Details

I. General information

NPI: 1346404431
Provider Name (Legal Business Name): CINDY J PETRIE RN, WOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7060 SPRINGHILL CIR
EDEN PRAIRIE MN
55346-2615
US

IV. Provider business mailing address

3057 PATTON RD
ROSEVILLE MN
55113-1042
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-9632
  • Fax:
Mailing address:
  • Phone: 651-428-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberR-169133-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: