Healthcare Provider Details

I. General information

NPI: 1952568842
Provider Name (Legal Business Name): LORI KAY FENNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NORTH AVE
GRAND JCT CO
81501-6428
US

IV. Provider business mailing address

2254 TELLIS CT
GRAND JCT CO
81505-8310
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-5062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number219
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: