Healthcare Provider Details

I. General information

NPI: 1710936562
Provider Name (Legal Business Name): MICHAEL A CLINE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 05/04/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 E MAIN ST
SPRINGVILLE NY
14141-1437
US

IV. Provider business mailing address

PO BOX 21
FRANKLINVILLE NY
14737-0021
US

V. Phone/Fax

Practice location:
  • Phone: 716-685-2167
  • Fax: 718-395-1571
Mailing address:
  • Phone: 716-685-6730
  • Fax: 718-395-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: