Provider Demographics
NPI:1972834398
Name:BRAND, LORI BARON (NP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BARON
Last Name:BRAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MICHELLE
Other - Last Name:BARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31291 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1458
Mailing Address - Country:US
Mailing Address - Phone:419-531-2127
Mailing Address - Fax:419-531-2664
Practice Address - Street 1:2975 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3786
Practice Address - Country:US
Practice Address - Phone:419-531-2127
Practice Address - Fax:419-531-2664
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704237406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner