Individual
TERA L LOTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P
Contact information
Practice address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9686
(616) 252-5202
Mailing address
5900 BYRON CENTER AVE SW # MC845, WYOMING, MI 49519-9686
(616) 252-7200
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704236439
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043459167
—
MI
Enumeration date
02/12/2009
Last updated
02/05/2019
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