Healthcare Provider Details

I. General information

NPI: 1952654493
Provider Name (Legal Business Name): LORI DORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35511 COUNTY ROAD 134
FAIRVIEW MT
59221-9465
US

IV. Provider business mailing address

35511 COUNTY ROAD 134
FAIRVIEW MT
59221-9465
US

V. Phone/Fax

Practice location:
  • Phone: 406-742-5201
  • Fax: 406-742-3523
Mailing address:
  • Phone: 406-742-5201
  • Fax: 406-742-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN13436
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN72765
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: