Provider Demographics
NPI:1194707182
Name:KREFMAN, LORI LYNN (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:KREFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:LENNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3408 MILLER RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4111
Mailing Address - Country:US
Mailing Address - Phone:269-350-7194
Mailing Address - Fax:269-350-5030
Practice Address - Street 1:3408 MILLER RD
Practice Address - Street 2:SUITE 301
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4111
Practice Address - Country:US
Practice Address - Phone:269-350-7194
Practice Address - Fax:269-350-5030
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117815363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4940228Medicaid
MIM97850012Medicare PIN
MIS61721Medicare UPIN