| Doctor Name: | LORI ANN BOOMS |
| NPI Number: | 1265432330 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | 4704168055 |
| Business Practice Address: | 100 N Roland St Mc Bain, MI - 496579683 |
| Business Phone Number: | 2318258101 |
| Business Fax Number: | 2318258104 |
| Mailing Address: | Po Box 533, GRAYLING |
| State: | MI |
| Postal Code: | 497380533 |
| Phone Number: | 2318767857 |
| Fax Number: | 2318767176 |
| NPI Enumeration Date: | 07/29/2005 |
| NPI Last Update Date: | 06/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704168055 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |