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Organization
SYNANON INC
Active
Organization
SYNANON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DON LONGPRE (CFO)
(616) 847-5323
Entity
Organization
Contact information
Practice address
1091 S BEACON BLVD, GRAND HAVEN, MI 49417-2607
(616) 604-0096
Mailing address
1091 S BEACON BLVD, GRAND HAVEN, MI 49417-2607
(616) 604-0096
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G1123
BCBS CNP GROUP
MI
Enumeration date
08/08/2007
Last updated
07/08/2009
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