Healthcare Provider Details

I. General information

NPI: 1659470482
Provider Name (Legal Business Name): LORRAINE (LORI) MARTIN-PLANK NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 BLAIR MILL RD
HORSHAM PA
19044-2223
US

IV. Provider business mailing address

680 BLAIR MILL RD
HORSHAM PA
19044-2223
US

V. Phone/Fax

Practice location:
  • Phone: 215-902-9014
  • Fax: 888-816-8109
Mailing address:
  • Phone: 215-902-9014
  • Fax: 888-816-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberVP001104B
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN09997600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: