Healthcare Provider Details

I. General information

NPI: 1114106812
Provider Name (Legal Business Name): CHRISTINE CORDRAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29745 E CHANNEL RD
DRUMMOND ISLAND MI
49726-9699
US

IV. Provider business mailing address

29745 E CHANNEL RD
DRUMMOND ISLAND MI
49726-9699
US

V. Phone/Fax

Practice location:
  • Phone: 906-493-6644
  • Fax: 906-493-6666
Mailing address:
  • Phone: 906-493-6644
  • Fax: 906-493-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4704170765
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: