Provider Demographics
NPI:1043624810
Name:LAURIE, ALLISON (NP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LAURIE
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 1:5401 MCAULEY DRIVE
Mailing Address - Street 2:P.O. BOX 995
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-0995
Mailing Address - Country:US
Mailing Address - Phone:734-712-5869
Mailing Address - Fax:734-712-5745
Practice Address - Street 1:5401 MCAULEY DRIVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106-0995
Practice Address - Country:US
Practice Address - Phone:734-712-5869
Practice Address - Fax:734-712-5745
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272553163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse