Provider Demographics
NPI:1720606098
Name:MAI, CYNTHIA LYNN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:MAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:LANHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1402 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3182
Mailing Address - Country:US
Mailing Address - Phone:989-486-1044
Mailing Address - Fax:
Practice Address - Street 1:3085 HALLMARK CT STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-6803
Practice Address - Country:US
Practice Address - Phone:989-996-0566
Practice Address - Fax:989-401-2876
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301694363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health