Individual
MRS. LORI KATHRYN BRICKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
205 N. EAST AVE., JACKSON, MI 49201
(517) 788-4800
Mailing address
PO BOX 100, ROYAL OAK, MI 48068-0100
(248) 849-3137
(248) 849-2052
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005355
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005355
MI STATE MEDICAL LICENSE (TEMP)
MI
Enumeration date
09/26/2008
Last updated
02/11/2010
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