MEDICARE: LORIE DANCY MSN RN

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	163WG0600X	Gerontology Registered Nurse	RN342866L	PA

General Provider Information

NPI Number	:	1649056938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE DANCY MSN RN

Provider Business Mailing Address
First Line	:	22 FOX RUN DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3255
Country	:	US
Telephone Number	:	732-921-6994
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 FOX RUN DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3255
Country	:	US
Telephone Number	:	732-921-6994
Fax Number	:

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

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	10/12/2023

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