MEDICARE: LORRI LYNN DAVISON A.P.R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	110672	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	245521	OTHER	NE	MIDLANDS CHOICE NUMBER
2	37969	OTHER	NE	BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285605808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRI LYNN DAVISON A.P.R.N.

Provider Business Mailing Address
First Line	:	1242 N TURNER AVE
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-7669
Country	:	US
Telephone Number	:	402-463-7647
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 N KANSAS AVE
Second Line	:	SUITE 100
City	:	HASTINGS
State	:	NE
Zip	:	68901-4470
Country	:	US
Telephone Number	:	402-460-5899
Fax Number	:	402-460-5619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	09/17/2008

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