Healthcare Provider Details

I. General information

NPI: 1578535076
Provider Name (Legal Business Name): CYNTHIA JANE HIBBS C.P.N.P.-P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA JANE BREMMER

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 RIDGEDALE DR STE 100
MINNETONKA MN
55305-1781
US

IV. Provider business mailing address

14001 RIDGEDALE DR STE 100
MINNETONKA MN
55305-1781
US

V. Phone/Fax

Practice location:
  • Phone: 952-473-0211
  • Fax: 952-473-7908
Mailing address:
  • Phone: 952-473-0211
  • Fax: 952-473-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP1771
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR1083026
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: