Individual
LORI COSTANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4768 RIVER RD, SODUS, MI 49126-9789
(269) 983-0300
Mailing address
4768 RIVER RD, SODUS, MI 49126-9789
(269) 983-0300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704238940
MI
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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