Healthcare Provider Details

I. General information

NPI: 1013690254
Provider Name (Legal Business Name): LORRIE JEAN JELIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 MCGINLEY RD
MONROEVILLE PA
15146-4400
US

IV. Provider business mailing address

2380 MCGINLEY RD
MONROEVILLE PA
15146-4400
US

V. Phone/Fax

Practice location:
  • Phone: 855-740-1921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN523939L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: