Healthcare Provider Details

I. General information

NPI: 1801561550
Provider Name (Legal Business Name): LORI WASHING ACNP-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 N FAIRFIELD RD STE B
BEAVERCREEK OH
45431-2579
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-458-0085
  • Fax:
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP0029526
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: