Healthcare Provider Details

I. General information

NPI: 1447640727
Provider Name (Legal Business Name): LORI N. EDGINGTON APRN.CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 1480
DAYTON OH
45409-2939
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7240
  • Fax: 937-208-7242
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.16998-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: