Provider Demographics
NPI:1740514686
Name:DILLON, CYNTHIA M (LPN)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:DILLON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:611 LUCILLE DR
Mailing Address - Street 2:WALLED LAKE
Mailing Address - City:WOLVERINE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2326
Mailing Address - Country:US
Mailing Address - Phone:248-842-8920
Mailing Address - Fax:
Practice Address - Street 1:2850 S INDUSTRIAL HWY
Practice Address - Street 2:SUITE 75
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6796
Practice Address - Country:US
Practice Address - Phone:734-477-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703033837164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse