=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770606170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN RENEE CIPA NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 03/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 W ANN ARBOR TRL SUITE 102
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48170-6204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-414-1088
-----------------------------------------------------
Fax | 734-414-1095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 990 W ANN ARBOR TRL SUITE 102
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48170-6204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-414-1088
-----------------------------------------------------
Fax | 734-414-1095
-----------------------------------------------------
=====================================================
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 | 4704237407
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------