Healthcare Provider Details

I. General information

NPI: 1285783399
Provider Name (Legal Business Name): LORI L VERNON AA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI JOSS AA

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

933 BRADBURY SE SUITE 2222
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax: 505-272-1300
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number003714
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA2007-001
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: