Basic Information
| Provider Information | |||||||||
| NPI: | 1043511470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRY | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172631800 | ||||||||
| FaxNumber: | 5172631866 | ||||||||
| Practice Location | |||||||||
| Address1: | 8765 LEWIS AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPERANCE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481829583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348473802 | ||||||||
| FaxNumber: | 7348473418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2010 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704184698 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.