Provider Demographics
NPI:1265742704
Name:CHODUN, CAROL LYNN (ACNP-BC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:CHODUN
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Gender:F
Credentials:ACNP-BC
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Mailing Address - Street 1:24211 LITTLE MACK AVE
Mailing Address - Street 2:EASTLAKE CARDIOVASCULAR
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:586-498-0440
Mailing Address - Fax:586-498-0401
Practice Address - Street 1:24211 LITTLE MACK AVENUE
Practice Address - Street 2:EASTLAKE CARDIOVASCULAR
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080
Practice Address - Country:US
Practice Address - Phone:586-498-0440
Practice Address - Fax:586-498-0401
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2011-11-03
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Provider Licenses
StateLicense IDTaxonomies
MI4704229927363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care