Provider Demographics
NPI:1326448036
Name:CYCZ, JOHN-MICHAEL (AGANCP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN-MICHAEL
Middle Name:
Last Name:CYCZ
Suffix:
Gender:M
Credentials:AGANCP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 410
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-781-5735
Practice Address - Fax:413-781-6391
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282453363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care