Healthcare Provider Details

I. General information

NPI: 1659400133
Provider Name (Legal Business Name): LORI MICHELLE HUNTSMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 SHEPHERDSVILLE RD
LOUISVILLE KY
40219-2215
US

IV. Provider business mailing address

7015 SHEPHERDSVILLE RD
LOUISVILLE KY
40219-2215
US

V. Phone/Fax

Practice location:
  • Phone: 502-968-7182
  • Fax:
Mailing address:
  • Phone: 502-968-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1109737
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28170233A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: