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General NPI Number Information
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NPI Number | 1003537408
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Entity Type | Individual
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Provider Name | LORI SHAKOUR FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 4 PARAGON WAY STE 300
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City | FREEHOLD
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State | NJ
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Zip | 07728-7805
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Country | US
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Telephone | 732-462-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 363 LODI CT
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City | BELFORD
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State | NJ
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Zip | 07718-1016
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Country | US
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Telephone | 908-601-6544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01351000
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License Number State | NJ
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