Provider Demographics
NPI:1477116291
Name:LAROY, LEE ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
Last Name:LAROY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:ANN
Other - Last Name:LYCZKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 SUNFOREST CT
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-473-6670
Mailing Address - Fax:419-473-9959
Practice Address - Street 1:3900 SUNFOREST CT
Practice Address - Street 2:SUITE 215
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-473-6670
Practice Address - Fax:419-473-9959
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704323763363LF0000X
OH024370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily