MEDICARE: LORELLA L PRITT LPN

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	164W00000X	Licensed Practical Nurse	P013001	SD

General Provider Information

NPI Number	:	1588217400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORELLA L PRITT LPN

Provider Business Mailing Address
First Line	:	708 SOUTHSIDE ST
Second Line	:
City	:	VALLEY SPRINGS
State	:	SD
Zip	:	57068-9354
Country	:	US
Telephone Number	:	605-757-6155
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 SOUTHSIDE ST
Second Line	:
City	:	VALLEY SPRINGS
State	:	SD
Zip	:	57068-9354
Country	:	US
Telephone Number	:	605-757-6155
Fax Number	:

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

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	07/19/2019

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