Provider Demographics
NPI:1588746325
Name:MUNRO, CYNTHIA DENISE (NP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:MUNRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:11615 HARTEL RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9165
Mailing Address - Country:US
Mailing Address - Phone:517-627-3281
Mailing Address - Fax:517-627-8722
Practice Address - Street 1:11615 HARTEL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-9165
Practice Address - Country:US
Practice Address - Phone:517-627-3281
Practice Address - Fax:517-627-8722
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704160373363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4832481Medicaid
MI5008765060OtherBCBS INDIVIDUAL PIN
MI4832481Medicaid
MI5008765060OtherBCBS INDIVIDUAL PIN