Healthcare Provider Details

I. General information

NPI: 1750027512
Provider Name (Legal Business Name): CHRISTINE NICOLE CIUCANU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S PENNSYLVANIA AVE
LANSING MI
48910-4700
US

IV. Provider business mailing address

4435 HERITAGE AVE APT 6B
OKEMOS MI
48864-3319
US

V. Phone/Fax

Practice location:
  • Phone: 517-394-0004
  • Fax:
Mailing address:
  • Phone: 517-505-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: