Healthcare Provider Details

I. General information

NPI: 1407544919
Provider Name (Legal Business Name): MRS. LAURA MARIE FORTUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TELEGRAPH RD
PONTIAC MI
48341-1032
US

IV. Provider business mailing address

9750 KENYON AVE
FENTON MI
48430-8222
US

V. Phone/Fax

Practice location:
  • Phone: 248-451-2600
  • Fax:
Mailing address:
  • Phone: 810-625-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: