1477766822 NPI number — MRS. LORI ANN DESHANE RN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477766822 NPI number — MRS. LORI ANN DESHANE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESHANE
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYDER
Provider Other First Name:
LORI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477766822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1029 WESTERN AVE # 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPDEN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04444-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-990-9000
Provider Business Mailing Address Fax Number:
207-945-8645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CUMBERLAND PL
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-990-9000
Provider Business Practice Location Address Fax Number:
207-945-8645
Provider Enumeration Date:
05/08/2007

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: 163WH0200X , with the licence number:  R051345 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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