Healthcare Provider Details

I. General information

NPI: 1912974395
Provider Name (Legal Business Name): CYNTHIA R ROBERTSON C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIRCLE CENTRACARE CLINIC - HEALTH PLAZA SPECIALTIES
ST CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIRCLE CENTRACARE CLINIC - HEALTH PLAZA SPECIALTIES
ST CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4907
  • Fax:
Mailing address:
  • Phone: 320-229-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMNR1154560
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR-115456-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: