Provider Demographics
NPI:1124593322
Name:RUSHLOW, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:RUSHLOW
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 1:3101 S GULLEY RD STE F
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4406
Mailing Address - Country:US
Mailing Address - Phone:734-407-2500
Mailing Address - Fax:313-792-8962
Practice Address - Street 1:3101 S GULLEY RD STE G
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4406
Practice Address - Country:US
Practice Address - Phone:734-407-2500
Practice Address - Fax:313-792-8962
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241415163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse