Healthcare Provider Details

I. General information

NPI: 1770606170
Provider Name (Legal Business Name): DAWN RENEE CIPA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W ANN ARBOR TRL SUITE 102
PLYMOUTH MI
48170-6204
US

IV. Provider business mailing address

990 W ANN ARBOR TRL SUITE 102
PLYMOUTH MI
48170-6204
US

V. Phone/Fax

Practice location:
  • Phone: 734-414-1088
  • Fax: 734-414-1095
Mailing address:
  • Phone: 734-414-1088
  • Fax: 734-414-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704237407
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: