Provider Demographics
NPI:1720400724
Name:LORI J. WARNER, PLLC
Entity Type:Organization
Organization Name:LORI J. WARNER, PLLC
Other - Org Name:DRAGONFLY CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-217-3396
Mailing Address - Street 1:1107 LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3322
Mailing Address - Country:US
Mailing Address - Phone:248-547-1621
Mailing Address - Fax:
Practice Address - Street 1:1107 LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3322
Practice Address - Country:US
Practice Address - Phone:248-217-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012531261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center