Provider Demographics
NPI:1144461914
Name:EGELSTON, CINDY LOU (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LOU
Last Name:EGELSTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-7410
Mailing Address - Country:US
Mailing Address - Phone:952-470-6005
Mailing Address - Fax:
Practice Address - Street 1:2018 STONE CREEK DR
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-7410
Practice Address - Country:US
Practice Address - Phone:952-470-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR106374-5163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse