Provider Demographics
NPI:1477179430
Name:LOURIM, EMILY L
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:LOURIM
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 1:1850 KRISTIN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1451
Mailing Address - Country:US
Mailing Address - Phone:248-494-6608
Mailing Address - Fax:
Practice Address - Street 1:1850 KRISTIN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1451
Practice Address - Country:US
Practice Address - Phone:248-494-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp