Healthcare Provider Details

I. General information

NPI: 1306260781
Provider Name (Legal Business Name): CYNTHIA CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W CARO RD
CARO MI
48723-9686
US

IV. Provider business mailing address

11189 GARDEN RDG
FREELAND MI
48623-8506
US

V. Phone/Fax

Practice location:
  • Phone: 989-672-2100
  • Fax:
Mailing address:
  • Phone: 989-928-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704167250
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: