MEDICARE: MS. LORI LEE PERRY CRNP

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	363LF0000X	Family Nurse Practitioner	UP006948B	PA
2	363L00000X	Nurse Practitioner	UP006948B	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GU040009	OTHER	PA	PA MEDICARE GROUP
3	CC9269	OTHER	PA	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316910318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI LEE PERRY CRNP

Provider Business Mailing Address
First Line	:	1 GUTHRIE SQ
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-1625
Country	:	US
Telephone Number	:	570-888-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	MANSFIELD UNIVERISTY
Second Line	:	HEALTH CLINIC
City	:	MANSFIELD
State	:	PA
Zip	:	16933
Country	:	US
Telephone Number	:	570-662-4350
Fax Number	:	570-662-4352

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	03/02/2021

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