Basic Information
| Provider Information | |||||||||
| NPI: | 1063834794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BICE | ||||||||
| FirstName: | CINNAMON | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STRAY | ||||||||
| OtherFirstName: | CINNAMON | ||||||||
| OtherMiddleName: | KAY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3809 OTTER LAKE RD | ||||||||
| Address2: | |||||||||
| City: | OTTER LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484649709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168198371 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1375 N MAIN ST | ||||||||
| Address2: | TRAUMA SURGERY DEPARTMENT | ||||||||
| City: | LAPEER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484461350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106675500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2014 | ||||||||
| LastUpdateDate: | 01/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.