Provider Demographics
NPI:1477283554
Name:WILKINS, LORI SUE
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:SUE
Last Name:WILKINS
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:W830 BASHORE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-9544
Mailing Address - Country:US
Mailing Address - Phone:906-298-1834
Mailing Address - Fax:
Practice Address - Street 1:248 FERRY LN
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1828
Practice Address - Country:US
Practice Address - Phone:906-984-2080
Practice Address - Fax:906-984-2190
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI175T00000XMedicaid