Provider Demographics
NPI:1154571875
Name:REICHERT-BROOKS, CINDY LEE (FNP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:LEE
Last Name:REICHERT-BROOKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:239 N STATE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9075
Mailing Address - Country:US
Mailing Address - Phone:989-743-3415
Mailing Address - Fax:989-743-6180
Practice Address - Street 1:239 N STATE RD STE 101
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9075
Practice Address - Country:US
Practice Address - Phone:989-743-3415
Practice Address - Fax:989-743-6180
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154571875Medicaid