Provider Demographics
NPI:1598101040
Name:PEARL-KRAUS, LORRAINE JOYCE (PHD, CS, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:JOYCE
Last Name:PEARL-KRAUS
Suffix:
Gender:F
Credentials:PHD, CS, FNP-BC
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:JOYCE
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, CS, FNP-BC
Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-493-9623
Mailing Address - Fax:616-242-0312
Practice Address - Street 1:235 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5247
Practice Address - Country:US
Practice Address - Phone:616-493-9623
Practice Address - Fax:616-242-0312
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704116202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily