Healthcare Provider Details

I. General information

NPI: 1982815833
Provider Name (Legal Business Name): CYNTHIA R BECKSTRAND MT,ASCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 74 AVE NE
FORT TOTTEN ND
58335-0309
US

IV. Provider business mailing address

3883 74 AVE NE
FORT TOTTEN ND
58335-0309
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-1600
  • Fax: 701-766-1640
Mailing address:
  • Phone: 701-766-1600
  • Fax: 701-766-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number#90-508897-I
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: