MEDICARE: MS. LORI MARIE HARSHMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	418464	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	418464	OTHER	CA	BRN

General Provider Information

NPI Number	:	1053829846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI MARIE HARSHMAN

Provider Business Mailing Address
First Line	:	35885 LODGE RD
Second Line	:
City	:	TOLLHOUSE
State	:	CA
Zip	:	93667-9624
Country	:	US
Telephone Number	:	559-269-1871
Fax Number	:

Provider Business Practice Location Address
First Line	:	35885 LODGE RD
Second Line	:
City	:	TOLLHOUSE
State	:	CA
Zip	:	93667-9624
Country	:	US
Telephone Number	:	559-269-1871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	06/16/2018

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