=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043290737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY JANDRON APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 E APPLE AVE SUITE # 201
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49442-3463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-725-4105
-----------------------------------------------------
Fax | 231-725-8196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1543 BROOKWOOD DR
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49441-5276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-798-7313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 4704137329
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------