Provider Demographics
NPI:1336223619
Name:MCNERLIN, CYNTHIA LEE (ANP-BC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:MCNERLIN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 BOSSETT
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9514
Mailing Address - Country:US
Mailing Address - Phone:616-847-1009
Mailing Address - Fax:616-847-1607
Practice Address - Street 1:17357 VAN WAGONER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8832
Practice Address - Country:US
Practice Address - Phone:616-847-1009
Practice Address - Fax:616-847-1607
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704184830363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health