MEDICARE: CYNTHIA R. BEHRENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	103967	CO

General Provider Information

NPI Number	:	1629550868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA R. BEHRENS

Provider Business Mailing Address
First Line	:	1900 E PIKES PEAK AVE STE 1
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5862
Country	:	US
Telephone Number	:	719-632-3757
Fax Number	:	719-632-2454

Provider Business Practice Location Address
First Line	:	1900 E PIKES PEAK AVE STE 1
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5862
Country	:	US
Telephone Number	:	719-632-3757
Fax Number	:	719-632-2454

Authorized Official
Title or Position	:	ADVANCE PRACTICE NURSE
Name	:	CYNTHIA R BEHRENS
Credential	:	APN
Telephone Number	:	719-632-3757

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	09/04/2018

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