1619283769 NPI number — LORI JANE WENDELL APRN, FNP-BC

Table of content: LORI JANE WENDELL APRN, FNP-BC (NPI 1619283769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619283769 NPI number — LORI JANE WENDELL APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENDELL
Provider First Name:
LORI
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLINS
Provider Other First Name:
LORI
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619283769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 CHASE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-382-2080
Provider Business Mailing Address Fax Number:
304-404-2057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 CHASE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-382-2080
Provider Business Practice Location Address Fax Number:
304-404-2057
Provider Enumeration Date:
08/27/2010

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:  37430 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN37430 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01087432 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810020023 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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