1013961440 NPI number — LORI BOLDT DRUCKER ARNP

Table of content: LORI BOLDT DRUCKER ARNP (NPI 1013961440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013961440 NPI number — LORI BOLDT DRUCKER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRUCKER
Provider First Name:
LORI
Provider Middle Name:
BOLDT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013961440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 LAKE WORTH RD STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33463-3213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-968-7968
Provider Business Mailing Address Fax Number:
561-964-4603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 JFK DR
Provider Second Line Business Practice Location Address:
MEDICAL SPECIALISTS OF THE PLAM BEACHES
Provider Business Practice Location Address City Name:
ATLANTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-968-6767
Provider Business Practice Location Address Fax Number:
561-641-0814
Provider Enumeration Date:
05/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP1285142 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)