Individual
LORI ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
524 W CENTRE AVE, PORTAGE, MI 49024-5306
(269) 324-1180
Mailing address
8056 GREENFIELD SHORES DR, SCOTTS, MI 49088-9735
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704198395
MI
Other
Enumeration date
02/19/2020
Last updated
02/19/2020
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