Healthcare Provider Details

I. General information

NPI: 1548057946
Provider Name (Legal Business Name): LORI POPA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SUMMIT DR
WATERFORD MI
48328-3364
US

IV. Provider business mailing address

279 SUMMIT DR
WATERFORD MI
48328-3364
US

V. Phone/Fax

Practice location:
  • Phone: 248-745-4900
  • Fax:
Mailing address:
  • Phone: 248-745-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number4704331114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: