Provider Demographics
NPI:1114106812
Name:CORDRAY, CHRISTINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CORDRAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29745 E CHANNEL RD
Mailing Address - Street 2:
Mailing Address - City:DRUMMOND ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49726-9699
Mailing Address - Country:US
Mailing Address - Phone:906-493-6644
Mailing Address - Fax:906-493-6666
Practice Address - Street 1:29745 E CHANNEL RD
Practice Address - Street 2:
Practice Address - City:DRUMMOND ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49726-9699
Practice Address - Country:US
Practice Address - Phone:906-493-6644
Practice Address - Fax:906-493-6666
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170765208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM53070001Medicare PIN
MIS44668Medicare UPIN