1043290737 NPI number — CINDY JANDRON APN

Table of content: CINDY JANDRON APN (NPI 1043290737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043290737 NPI number — CINDY JANDRON APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANDRON
Provider First Name:
CINDY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOKARZ
Provider Other First Name:
CINDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043290737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1543 BROOKWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49441-5276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-798-7313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 E APPLE AVE
Provider Second Line Business Practice Location Address:
SUITE # 201
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442-3463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-725-4105
Provider Business Practice Location Address Fax Number:
231-725-8196
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  4704137329 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4493565 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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