Provider Demographics
NPI:1467630145
Name:KLOPFENSTEIN, LORI ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:KLOPFENSTEIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:CHUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1663 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1928
Practice Address - Country:US
Practice Address - Phone:269-694-3001
Practice Address - Fax:269-359-3724
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214201363LF0000X
IN71002606A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN603454OtherBCBS
IN200932210Medicaid
MI1467630145Medicaid
INM400014756OtherMEDICARE