Healthcare Provider Details

I. General information

NPI: 1740548320
Provider Name (Legal Business Name): LORI LYNNE JUAREZ MSN, APRN, BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 W MEETING ST BLDG 5H
LANCASTER SC
29720-6233
US

IV. Provider business mailing address

838 W MEETING ST BLDG 5H
LANCASTER SC
29720-6233
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-2273
  • Fax: 803-286-0599
Mailing address:
  • Phone: 803-285-2273
  • Fax: 803-286-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17796
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: