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General NPI Number Information
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NPI Number | 1447608625
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Entity Type | Individual
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Provider Name | MISS LORRAINE CLOSSER
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Gender | Female
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Dates
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Enumeration Date | 05/29/2016
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Last Update Date | 05/29/2016
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Provider Practice Location Address
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Address Line | 68753 S MAIN ST
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City | RICHMOND
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State | MI
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Zip | 48062-1209
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Country | US
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Telephone | 810-887-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 6870 PERRY RD
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City | BROCKWAY
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State | MI
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Zip | 48097-3909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 7501006247
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License Number State | MI
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