Provider Demographics
NPI:1487226924
Name:CEGLAREK, CHRISTINE L
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:CEGLAREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2274
Mailing Address - Country:US
Mailing Address - Phone:231-330-3585
Mailing Address - Fax:231-487-4001
Practice Address - Street 1:560 W MITCHELL ST STE 400
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2274
Practice Address - Country:US
Practice Address - Phone:231-330-3585
Practice Address - Fax:231-487-4001
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230547363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner