Provider Demographics
NPI:1720743545
Name:AVASILCAI, CRISTIAN PETRISOR (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:PETRISOR
Last Name:AVASILCAI
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 COLONADE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5804
Mailing Address - Country:US
Mailing Address - Phone:248-787-3269
Mailing Address - Fax:
Practice Address - Street 1:2142 N COVE BLVD # 201
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-1111
Practice Address - Fax:419-479-3253
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300103363LA2100X, 363L00000X
OHAPRN.CNP.0031011363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care