Individual
LORA COMMISSARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
12851 W M 179 HWY, WAYLAND, MI 49348-9318
(877) 377-7322
Mailing address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010293
MI
Other
Enumeration date
11/13/2020
Last updated
07/05/2022
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