Healthcare Provider Details

I. General information

NPI: 1881080356
Provider Name (Legal Business Name): LORI ANN CARLOUGH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2015
Last Update Date: 04/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 CASCADE DR
PLANO TX
75025-4106
US

IV. Provider business mailing address

2821 CASCADE DR
PLANO TX
75025-4106
US

V. Phone/Fax

Practice location:
  • Phone: 972-672-5606
  • Fax:
Mailing address:
  • Phone: 972-672-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number564932
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: