MEDICARE: CYNTHIA R BECKSTRAND MT,ASCP

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	246QM0706X	Medical Technologist	#90-508897-I	ND

General Provider Information

NPI Number	:	1982815833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA R BECKSTRAND MT,ASCP

Provider Business Mailing Address
First Line	:	3883 74 AVE NE
Second Line	:
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335-0309
Country	:	US
Telephone Number	:	701-766-1600
Fax Number	:	701-766-1640

Provider Business Practice Location Address
First Line	:	3883 74 AVE NE
Second Line	:
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335-0309
Country	:	US
Telephone Number	:	701-766-1600
Fax Number	:	701-766-1640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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