Healthcare Provider Details

I. General information

NPI: 1043599467
Provider Name (Legal Business Name): LORI'S RNFA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SPRING PARK RDG
CARBONDALE CO
81623-8944
US

IV. Provider business mailing address

825 SPRING PARK RDG
CARBONDALE CO
81623-8944
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-2997
  • Fax:
Mailing address:
  • Phone: 970-963-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number140252
License Number StateCO

VIII. Authorized Official

Name: MS. LORI D HUBBELL
Title or Position: RNFA
Credential: RNFA
Phone: 970-963-2997