Provider Demographics
NPI:1750605242
Name:CRANDELL, CYNTHIA ANN (RN, CN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:RN, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 1/2 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5302
Mailing Address - Country:US
Mailing Address - Phone:248-766-2210
Mailing Address - Fax:248-922-7081
Practice Address - Street 1:5 1/2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5302
Practice Address - Country:US
Practice Address - Phone:248-766-2210
Practice Address - Fax:248-922-7081
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704185428164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704185428OtherRN LICENSE