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General NPI Number Information
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NPI Number | 1720310170
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Entity Type | Individual
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Provider Name | LORRI M PETTERSON RN
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Gender | Female
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 863 NE HIDDEN VALLEY DR UNIT 1
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City | BEND
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State | OR
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Zip | 97701-6575
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Country | US
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Telephone | 541-350-3945
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Fax |
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Provider Business Mailing Address
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Address Line | 863 NE HIDDEN VALLEY DR UNIT 1
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City | BEND
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State | OR
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Zip | 97701-6575
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Country | US
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Telephone | 541-350-3945
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 200941831
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 200830291
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License Number State | OR
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