Healthcare Provider Details

I. General information

NPI: 1801530860
Provider Name (Legal Business Name): CAYLEE LAWNICHAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 BOURN ST
LEWISTON MI
49756-8134
US

IV. Provider business mailing address

3040 BOURN ST
LEWISTON MI
49756-8134
US

V. Phone/Fax

Practice location:
  • Phone: 989-786-4877
  • Fax:
Mailing address:
  • Phone: 989-786-4877
  • Fax: 989-786-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011094
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: