Healthcare Provider Details

I. General information

NPI: 1992742357
Provider Name (Legal Business Name): CYNTHIA JEAN BETZLER RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR CENTRACARE CLINIC WOMENS & CHILDRENS
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR CENTRACARE CLINIC WOMENS & CHILDRENS
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-654-3610
  • Fax:
Mailing address:
  • Phone: 320-654-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR1270949
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: