Individual
MS. LUCETTA LYNNE LYFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
430 W. CENTRE AVE., PORTAGE, MI 49024
(269) 321-6673
Mailing address
430 W. CENTRE AVE., PORTAGE, MI 49024
(269) 321-6673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003467
MI
Other
Enumeration date
06/13/2005
Last updated
08/07/2007
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