Individual
LORI CHARBONNEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2349
(231) 935-5000
Mailing address
2513 MOMENTUM PL, CHICAGO, IL 60689-5325
(231) 876-7476
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
4704118878
MI
Other
Enumeration date
10/12/2015
Last updated
03/29/2017
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