Provider Demographics
NPI:1043308307
Name:BEERS, LORRAINE (NP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:BEERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 6TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2359
Mailing Address - Country:US
Mailing Address - Phone:231-935-5090
Mailing Address - Fax:231-935-5093
Practice Address - Street 1:1221 6TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2359
Practice Address - Country:US
Practice Address - Phone:231-935-5090
Practice Address - Fax:231-935-5093
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704118882363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4915127Medicaid
MI4915127Medicaid
MI0B86016117Medicare PIN