Healthcare Provider Details

I. General information

NPI: 1902263668
Provider Name (Legal Business Name): LOIS FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7626 W PARKWAY ST
REDFORD MI
48239-1070
US

IV. Provider business mailing address

7626 W PARKWAY ST
REDFORD MI
48239-1070
US

V. Phone/Fax

Practice location:
  • Phone: 248-461-7468
  • Fax:
Mailing address:
  • Phone: 248-461-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703115040
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: