Healthcare Provider Details

I. General information

NPI: 1295944924
Provider Name (Legal Business Name): CINDI FAYE PUTRAH LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STATE AVE
FARIBAULT MN
55021-6339
US

IV. Provider business mailing address

200 STATE AVE
FARIBAULT MN
55021-6339
US

V. Phone/Fax

Practice location:
  • Phone: 507-332-4736
  • Fax: 507-332-4848
Mailing address:
  • Phone: 507-332-4736
  • Fax: 507-332-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number726482
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: