Provider Demographics
NPI:1033971056
Name:MCINTOSH, CYNTHIA MICHELLE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MICHELLE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST STE M-170
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5366
Mailing Address - Country:US
Mailing Address - Phone:269-381-7169
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE M-170
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5366
Practice Address - Country:US
Practice Address - Phone:269-381-7169
Practice Address - Fax:269-381-1655
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271698163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice