Basic Information
| Provider Information | |||||||||
| NPI: | 1649259904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAUGSDAL | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | SUZETTE | ||||||||
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| Credential: | RN CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4970 BALSAM AVE | ||||||||
| Address2: | |||||||||
| City: | NORTHWOOD | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504598726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6412935450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 404 W FOUNTAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALBERT LEA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560072437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073732384 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | R 091201-7 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | 65 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.