Healthcare Provider Details

I. General information

NPI: 1578063418
Provider Name (Legal Business Name): LORI LOVING ARCHAMBEAU LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8442 N STATE HIGHWAY 94
GROVETON TX
75845-2362
US

IV. Provider business mailing address

6021 FM 842
LUFKIN TX
75901-2250
US

V. Phone/Fax

Practice location:
  • Phone: 936-366-8086
  • Fax:
Mailing address:
  • Phone: 936-366-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number153028
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number153028X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: