Individual
LORI ANN BOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4328 PAGE AVE, MICHIGAN CENTER, MI 49254-1077
(517) 764-3609
Mailing address
2619 MARION RD, JACKSON, MI 49201-8701
(517) 764-3609
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703100787
MI
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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