Healthcare Provider Details

I. General information

NPI: 1861615635
Provider Name (Legal Business Name): CINDY RIERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 MILLWOOD AVE
ROSEVILLE MN
55113-1928
US

IV. Provider business mailing address

824 MILLWOOD AVE
ROSEVILLE MN
55113-1928
US

V. Phone/Fax

Practice location:
  • Phone: 651-490-9625
  • Fax:
Mailing address:
  • Phone: 651-490-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 110085-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: