Provider Demographics
NPI:1245340256
Name:HOPKINS, LORI L (PA-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAYSIDE ALLERGY
Mailing Address - Street 2:447 MUNSON AVE.
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-929-9090
Mailing Address - Fax:269-226-8804
Practice Address - Street 1:BAYSIDE ALLERGY
Practice Address - Street 2:447 MUNSON AVE.
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-929-9090
Practice Address - Fax:269-226-8804
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant