Provider Demographics
NPI:1770336117
Name:COLLINS, LORI JO (ATYPICAL PROVIDER)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:JO
Last Name:COLLINS
Suffix:
Gender:F
Credentials:ATYPICAL PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 N GEECK RD
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-9709
Mailing Address - Country:US
Mailing Address - Phone:989-721-2864
Mailing Address - Fax:
Practice Address - Street 1:2687 N GEECK RD
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-9709
Practice Address - Country:US
Practice Address - Phone:989-721-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health