MEDICARE: CYNTHIA LEE MCNERLIN ANP-BC

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	363LA2200X	Adult Health Nurse Practitioner	4704184830	MI

General Provider Information

NPI Number	:	1336223619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LEE MCNERLIN ANP-BC

Provider Business Mailing Address
First Line	:	6301 BOSSETT
Second Line	:
City	:	COOPERSVILLE
State	:	MI
Zip	:	49404-9514
Country	:	US
Telephone Number	:	616-847-1009
Fax Number	:	616-847-1607

Provider Business Practice Location Address
First Line	:	17357 VAN WAGONER RD
Second Line	:	SUITE 2
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-8832
Country	:	US
Telephone Number	:	616-847-1009
Fax Number	:	616-847-1607

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/30/2010

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