Individual
LORRAINE MAVIS LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 OSBORN BLVD, SAULT SAINTE MARIE, MI 49783-1822
(906) 635-4460
Mailing address
500 OSBORN BLVD, SAULT SAINTE MARIE, MI 49783-1822
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704213227
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704213227
MICHIGAN LICENSE
MI
Enumeration date
11/29/2017
Last updated
06/06/2023
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