Healthcare Provider Details

I. General information

NPI: 1700369923
Provider Name (Legal Business Name): CINDY RISING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WALNUT ST
SUTHERLAND NE
69165-7257
US

IV. Provider business mailing address

PO BOX 217
SUTHERLAND NE
69165-0217
US

V. Phone/Fax

Practice location:
  • Phone: 308-386-4656
  • Fax: 308-386-2426
Mailing address:
  • Phone: 308-386-4656
  • Fax: 308-386-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number46555
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: