Provider Demographics
NPI:1346790920
Name:CYNTHIA J PAPENDICK INC
Entity Type:Organization
Organization Name:CYNTHIA J PAPENDICK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAPENDICK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:269-470-0832
Mailing Address - Street 1:16170 RED ARROW HWY
Mailing Address - Street 2:SUITE C-8
Mailing Address - City:UNION PIER
Mailing Address - State:MI
Mailing Address - Zip Code:49129-9473
Mailing Address - Country:US
Mailing Address - Phone:269-470-0832
Mailing Address - Fax:269-469-1202
Practice Address - Street 1:16170 RED ARROW HWY
Practice Address - Street 2:SUITE C-8
Practice Address - City:UNION PIER
Practice Address - State:MI
Practice Address - Zip Code:49129-9473
Practice Address - Country:US
Practice Address - Phone:269-470-0832
Practice Address - Fax:269-469-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169270364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty