Provider Demographics
NPI:1063834794
Name:BICE, CINNAMON (PA-C)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:
Last Name:BICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CINNAMON
Other - Middle Name:KAY
Other - Last Name:STRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3809 OTTER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OTTER LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48464-9709
Mailing Address - Country:US
Mailing Address - Phone:616-819-8371
Mailing Address - Fax:
Practice Address - Street 1:1375 N MAIN ST
Practice Address - Street 2:TRAUMA SURGERY DEPARTMENT
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1350
Practice Address - Country:US
Practice Address - Phone:810-667-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant