1588844229 NPI number — MRS. LORI ANN MILLER HARRELL APRN, BC

Table of content: MRS. LORI ANN MILLER HARRELL APRN, BC (NPI 1588844229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588844229 NPI number — MRS. LORI ANN MILLER HARRELL APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRELL
Provider First Name:
LORI
Provider Middle Name:
ANN MILLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER HARRELL
Provider Other First Name:
LORI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588844229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 15TH STREET, FA2030
Provider Second Line Business Mailing Address:
DEPARTMENT OF EMERGENCY MEDICINE, DIVISION OF HOSPITALI
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-721-6016
Provider Business Mailing Address Fax Number:
706-721-7718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2260 WRIGHTSBORO RD.
Provider Second Line Business Practice Location Address:
TRINITY HOSPITAL
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-481-7391
Provider Business Practice Location Address Fax Number:
706-481-7393
Provider Enumeration Date:
11/09/2007

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: 363LF0000X , with the licence number:  RN071579NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000967216A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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