Healthcare Provider Details

I. General information

NPI: 1720175102
Provider Name (Legal Business Name): LORI A NORMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 UNIONVILLE RD
KENNETT SQUARE PA
19348-4701
US

IV. Provider business mailing address

567 UNIONVILLE RD
KENNETT SQUARE PA
19348-4701
US

V. Phone/Fax

Practice location:
  • Phone: 610-444-3356
  • Fax:
Mailing address:
  • Phone: 610-444-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StatePA

VIII. Authorized Official

Name: LORI ANN NORMAN
Title or Position: PRESIDENT
Credential: CRNA MS
Phone: 610-444-3356