Healthcare Provider Details

I. General information

NPI: 1407589757
Provider Name (Legal Business Name): LORI HOLLOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI HURLBUT

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 PLAYERS CLUB PKWY
MEMPHIS TN
38125-8933
US

IV. Provider business mailing address

5545 MURRAY AVE STE 130
MEMPHIS TN
38119-3861
US

V. Phone/Fax

Practice location:
  • Phone: 901-844-1590
  • Fax:
Mailing address:
  • Phone: 901-682-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number32296
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: