Healthcare Provider Details

I. General information

NPI: 1508029968
Provider Name (Legal Business Name): LORI NOREEN MULFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 ROUTE 44
PLEASANT VALLEY NY
12569-7832
US

IV. Provider business mailing address

43 FALLKILL RD #16
HYDE PARK NY
12538-3138
US

V. Phone/Fax

Practice location:
  • Phone: 845-635-8084
  • Fax: 845-635-8083
Mailing address:
  • Phone: 845-635-8084
  • Fax: 845-635-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number320757-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number320757-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: