Healthcare Provider Details

I. General information

NPI: 1467116178
Provider Name (Legal Business Name): LORI BERRANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GREENE ST
MARIETTA OH
45750-3134
US

IV. Provider business mailing address

218 BEAVER ST
MARIETTA OH
45750-2502
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-0769
  • Fax:
Mailing address:
  • Phone: 209-380-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number402876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: