Provider Demographics
NPI:1831920248
Name:WILLARD, LORI ANNE
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:WILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W BROADWELL ST APT 15
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1079
Mailing Address - Country:US
Mailing Address - Phone:517-554-7689
Mailing Address - Fax:
Practice Address - Street 1:404 W BROADWELL ST APT 15
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1079
Practice Address - Country:US
Practice Address - Phone:517-554-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health