Healthcare Provider Details

I. General information

NPI: 1265495535
Provider Name (Legal Business Name): CYNTHIA A ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 MOUNT RUSHMORE RD
RAPID CITY SD
57701-5462
US

IV. Provider business mailing address

2820 MOUNT RUSHMORE RD
RAPID CITY SD
57701-5462
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-8354
  • Fax: 605-721-8458
Mailing address:
  • Phone: 605-721-8354
  • Fax: 605-721-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0726
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number9503
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: