Provider Demographics
NPI:1922219260
Name:MORIN, CYNTHIA (PA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MORIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-522-8540
Mailing Address - Fax:734-522-5405
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-522-8540
Practice Address - Fax:734-522-5405
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601001697OtherSTATE LICENSE