Healthcare Provider Details

I. General information

NPI: 1952789257
Provider Name (Legal Business Name): CYNTHIA MCCARTY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26150 5 MILE RD STE 31
REDFORD MI
48239-3240
US

IV. Provider business mailing address

26150 5 MILE RD STE 31
REDFORD MI
48239-3240
US

V. Phone/Fax

Practice location:
  • Phone: 313-740-7364
  • Fax:
Mailing address:
  • Phone: 313-740-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703111307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: