Healthcare Provider Details

I. General information

NPI: 1528402096
Provider Name (Legal Business Name): CYNTHIA JEAN KUDRAY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30800 TELEGRAPH RD SUITE 2800
BINGHAM FARMS MI
48025-4542
US

IV. Provider business mailing address

30800 TELEGRAPH RD SUITE 2800
BINGHAM FARMS MI
48025-4542
US

V. Phone/Fax

Practice location:
  • Phone: 248-593-0144
  • Fax:
Mailing address:
  • Phone: 248-593-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704136809
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: