Healthcare Provider Details

I. General information

NPI: 1982817953
Provider Name (Legal Business Name): LORI A REPP GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI A COPELAND

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST STE 152
WASHINGTON MO
63090-3128
US

IV. Provider business mailing address

851 E 5TH ST STE 152
WASHINGTON MO
63090-3128
US

V. Phone/Fax

Practice location:
  • Phone: 636-861-7880
  • Fax:
Mailing address:
  • Phone: 636-861-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number112881
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: